What is Biofilm?

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Biofilm is defined as a thin but robust layer of mucilage adhering to a solid surface and containing a community of bacteria and other microorganisms.

Biofilm formation has become a significant problem in the health industry and research has provided insight into understanding the processes involved in their formation, as well as methods to control their growth and spread. Biofilms may form on living or non-living surfaces and occur in natural, industrial and hospital settings.

For biofilm to form, there must be bacteria, a solid surface and moisture. After the bacteria have adhered to the surface, they start to multiply, and when a certain critical amount of them are present, they start to secrete a slimy layer over their surface, which then protects them from the environment and makes them more resistant to antibiotics (which cannot reach them). The biofilm, which by now has become a living growing entity, continues to grow until parts of it break free, dispersing and spreading the infection.

An interesting observation in biofilms is that bacteria communicate with each other via a process called quorum sensing (QS). QS is a bacterial cell-to-cell communication process via small messenger molecules that diffuse through the biofilm. Bacteria also use QS to regulate their metabolism in response to stresses from the environment, for example - if the slime cuts the bacteria off from oxygen they become anaerobe (oxygen-free) bacteria, making them even more dangerous in their ability to cause and prolong disease. QS acts as the brain of the biofilm. This makes biofilm a living, thinking and dangerous infection-causing entity, which is also resistant to antibiotics.

Another mechanism used by biofilm to resist antibiotics is through their growth rate - it is significantly slower in these organisms than the growth rate of planktonic (biofilm-free) bacteria. Bacteria need to metabolise antibiotics to be poisoned by them, resulting in their death. The lower metabolic rate means fewer antibiotics are taken up by the bacteria, which makes them more resistant to the antibiotics. Biofilm age may also be important because, with increasing age, there will be greater production of slime, leading to reduced nutrient and oxygen penetration into the biofilm slime.

The micro-organisms most frequently associated with biofilms include Gram-positive bacteria, such as Staphylococcus aureusStaphylococcus epidermidis and Enterococcus faecalis; Gram-negative bacteria, including Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Pseudomonas aeruginosa, and yeasts, particularly Candida species.

Biofilm has been associated with known chronic infections, for example, P. aeruginosa forms biofilms in the lungs of patients with cystic fibrosis and, despite the aggressive use of antibiotics, the presence of pseudomonas is often a life-long problem, leading to chronic inflammation and lung tissue damage. Biofilm-forming P. aeruginosa also has a role to play in chronic wound infections and forms biofilms in both human and veterinary wounds. Biofilm is also the major cause of inflammation in chronic wounds (wounds that do not want to heal).

The association between biofilms and medical device-related infections has been known since 1972. Medical publications started to report that biofilms occur in a wide range of medical devices, such as catheters, cardiac pacemakers and stents, dental implants, joint replacement prostheses, breast prostheses and ventilation tubing. In fact, as much as 50% of nosocomial infections are from these implanted devices. The dispersal of mature biofilm from these surfaces is a major risk of infection.

There is clearly a need to develop new, effective, and specific antibacterial substances and antiseptics to diminish the biofilm’s ability to cause disease in patients, resist antibiotics in hospitals, and remove biofilms from other public spaces like water reticulation systems.

A significant development in the control of biofilm is the discovery of methods to produce medical-grade hypochlorous acid (HOCl). HOCl is the body’s immune molecule that fights biofilms. HOCl has been known for more than a hundred years, but improved methods to manufacture HOCl over the last two decades have opened ways to fight biofilm. Thoclor Labs, a biotechnology company from Stellenbosch, has consistently made breakthroughs in the last few years in developing and perfecting medical-grade HOCl under the brand name Trifectiv® Plus. Trifectiv® Plus can not only break down biofilm slime, but also kill the bacteria (including antibiotic resistant bacteria), viruses, or fungi responsible for the formation of the biofilm. Trifectiv® Plus is also anti-inflammatory, which offers advantages over ordinary HOCl products as the control of inflammation heals wounds up to 70% faster when compared to other wound healing methods.

Trifectiv® Plus Wound & Burn Care & Trifectiv® Plus Air are available from leading independent pharmacies and via the Trifectivplus.com website. The Wound & Burn Care 100 ml product is also available on Takealot.

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