The Use of Probiotics to Fight Biofilms in Medical Devices: A Systematic Review and Meta-Analysis

Abstract

Medical device-associated infections (MDAI) are a critical problem due to the increasing usage of medical devices in the aging population. The inhibition of biofilm formation through the use of probiotics has received attention from the medical field in the last years. However, this sparse knowledge has not been properly reviewed, so that successful strategies for biofilm management can be developed. This study aims to summarize the relevant literature about the effect of probiotics and their metabolites on biofilm formation in medical devices using a PRISMA-oriented (Preferred Reporting Items for Systematic reviews and Meta-Analyses) systematic search and meta-analysis. This approach revealed that the use of probiotics and their products is a promising strategy to hinder biofilm growth by a broad spectrum of pathogenic microorganisms. The meta-analysis showed a pooled effect estimate for the proportion of biofilm reduction of 70% for biosurfactants, 76% for cell-free supernatants (CFS), 77% for probiotic cells and 88% for exopolysaccharides (EPS). This review also highlights the need to properly analyze and report data, as well as the importance of standardizing the in vitro culture conditions to facilitate the comparison between studies. This is essential to increase the predictive value of the studies and translate their findings into clinical applications.

Honey as an Ecological Reservoir of Antibacterial Compounds Produced by Antagonistic Microbial Interactions in Plant Nectars, Honey and Honey Bee

“…In addition to antimicrobial action of bacteriocins, LAB produce biosurfactants, a diverse group of amphipathic molecules that can modify physicochemical properties and integrity of the cell envelope by interacting with its components. The chemical nature of biosurfactants originated from different LAB strains ranges from proteinaceous compounds, glycolipidic, glycoproteins, to glycolipopeptides [ 94 , 95 , 96 , 97 , 98 ]. The key to their surfactant action is their amphipathic nature conferred by charge, hydrophobicity and degree of chemical modifications [ 94 , 95 , 96 , 97 , 98 ].…”

“…The chemical nature of biosurfactants originated from different LAB strains ranges from proteinaceous compounds, glycolipidic, glycoproteins, to glycolipopeptides [ 94 , 95 , 96 , 97 , 98 ]. The key to their surfactant action is their amphipathic nature conferred by charge, hydrophobicity and degree of chemical modifications [ 94 , 95 , 96 , 97 , 98 ]. Their interactions with membranes can lead to the reduction of the surface tension, a partial membrane solubilisation or change in membrane hydrophobicity and/or cell wall charge [ 94 ].…”

“…The changes in properties of the cell envelope affect biofilm formation, specifically the ability of bacterial cells to attach to the surfaces. The anti-biofilm activity of biosurfactants can result from a direct inhibition of biofilm formation, but also from the dispersal of the mature biofilms [ 95 , 97 , 98 ]. Biofilm development is the important microbial strategy in exploitive competition for nutrients acquisition and storage, the space colonization, spread and defence against the competition or host defences.…”

“…This property has been used in pre-coating of biomedical instruments and implants with the LAB biosurfactants to prevent attachment and biofilm formation by pathogenic bacteria, such as S. aureus , P. aeruginosa or C. albicans [ 103 ]. Biofilms of pathogenic bacteria developed on catheters, cardiac pacemakers, joint prosthetics, etc., are responsible for about 50% of hospital nosocomial infections [ 95 , 99 ]. Some of surfactants facilitated desorption of existing biofilms [ 95 ].…”

“…Biofilms of pathogenic bacteria developed on catheters, cardiac pacemakers, joint prosthetics, etc., are responsible for about 50% of hospital nosocomial infections [ 95 , 99 ]. Some of surfactants facilitated desorption of existing biofilms [ 95 ]. For example, biosurfactant produced by L. helveticus MRTL91 displayed a strong antimicrobial activity against biofilms of E. coli , C. albicans , P. aeruginosa , S. typhi , S. flexneri but in contrast rather weak antiadhesive activity suggesting the possibility of bacteriocins involvement in the biofilm degradation and bactericidal activity [ 103 ].…”