Laboratory of Pharmaceutical Microbiology, Ghent University, Ghent, Belgium.
Clin Microbiol Rev. 2023 Dec 20;36(4):e0002423. doi: 10.1128/cmr.00024-23. Epub 2023 Oct 9.
Our knowledge about the fundamental aspects of biofilm biology, including the mechanisms behind the reduced antimicrobial susceptibility of biofilms, has increased drastically over the last decades. However, this knowledge has so far not been translated into major changes in clinical practice. While the biofilm concept is increasingly on the radar of clinical microbiologists, physicians, and healthcare professionals in general, the standardized tools to study biofilms in the clinical microbiology laboratory are still lacking; one area in which this is particularly obvious is that of antimicrobial susceptibility testing (AST). It is generally accepted that the biofilm lifestyle has a tremendous impact on antibiotic susceptibility, yet AST is typically still carried out with planktonic cells. On top of that, the microenvironment at the site of infection is an important driver for microbial physiology and hence susceptibility; but this is poorly reflected in current AST methods. The goal of this review is to provide an overview of the state of the art concerning biofilm AST and highlight the knowledge gaps in this area. Subsequently, potential ways to improve biofilm-based AST will be discussed. Finally, bottlenecks currently preventing the use of biofilm AST in clinical practice, as well as the steps needed to get past these bottlenecks, will be discussed.
在过去的几十年中，我们对生物膜生物学的基本方面的认识，包括生物膜对抗生素敏感性降低的机制，有了很大的提高。然而，到目前为止，这些知识还没有转化为临床实践的重大改变。虽然生物膜概念越来越受到临床微生物学家、医生和一般医疗保健专业人员的关注，但在临床微生物学实验室研究生物膜的标准化工具仍然缺乏；在这方面，一个特别明显的领域是抗菌药物敏感性测试（AST）。人们普遍认为，生物膜的生活方式对抗生素敏感性有巨大影响，但 AST 通常仍然是用浮游细胞进行的。除此之外，感染部位的微环境是微生物生理学和因此的敏感性的重要驱动因素；但这在当前的 AST 方法中反映得很差。这篇综述的目的是概述生物膜 AST 的最新进展，并强调该领域的知识差距。随后，将讨论改善基于生物膜的 AST 的潜在方法。最后，将讨论目前阻碍生物膜 AST 在临床实践中应用的瓶颈，以及克服这些瓶颈所需的步骤。
