Biofilms cause chronic infections in tissues or by developing on the surfaces of medical devices. Biofilm infections persist despite both antibiotic therapy and the innate and adaptive defence mechanisms of the patient. Biofilm infections are characterized by persisting and progressive pathology due primarily to the inflammatory response surrounding the biofilm. For this reason, many biofilm infections may be difficult to diagnose and treat efficiently. It is the purpose of the guideline to bring the current knowledge of biofilm diagnosis and therapy to the attention of clinical microbiologists and infectious disease specialists. Selected hallmark biofilm infections in tissues (e.g. cystic fibrosis with chronic lung infection, patients with chronic wound infections) or associated with devices (e.g. orthopaedic alloplastic devices, endotracheal tubes, intravenous catheters, indwelling urinary catheters, tissue fillers) are the main focus of the guideline, but experience gained from the biofilm infections included in the guideline may inspire similar work in other biofilm infections. The clinical and laboratory parameters for diagnosing biofilm infections are outlined based on the patient's history, signs and symptoms, microscopic findings, culture-based or culture-independent diagnostic techniques and specific immune responses to identify microorganisms known to cause biofilm infections. First, recommendations are given for the collection of appropriate clinical samples, for reliable methods to specifically detect biofilms, for the evaluation of antibody responses to biofilms, for antibiotic susceptibility testing and for improvement of laboratory reports of biofilm findings in the clinical microbiology laboratory. Second, recommendations are given for the prevention and treatment of biofilm infections and for monitoring treatment effectiveness. Finally, suggestions for future research are given to improve diagnosis and treatment of biofilm infections.

Department of Clinical Microbiology Rigshospitalet Copenhagen Denmark

Department of Clinical Microbiology Rigshospitalet Copenhagen Denmark; Department of International Health Immunology and Microbiology University of Copenhagen Denmark

Department of Internal Medicine 2 Julius Maximilians University Würzburg Germany

Department of Microbial Infection and Immunity Center for Microbial Interface Biology Ohio State University Columbus OH USA

Department of Orthopaedic Surgery Hvidovre University Hospital Hvidovre Denmark

Department of Pulmonary and Critical Care Medicine Thorax Institute Hospital Clinic Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona; and University of Barcelona Barcelona Spain

Institut Pasteur Unité de Génétique des Biofilms Paris; Université Paris Descartes Sorbonne Paris Cité Hôpital Necker Enfants Malades Centre d'Infectiologie Necker Pasteur; and Institut Imagine Paris France

Institute for Microbiology Masaryk University and St Anne's University Hospital Brno Czech Republic

Institute of Healthcare Associated Infection University of the West of Scotland Paisley UK

Laboratoire Ecologie et Biologie des Interactions Université de Poitiers Poitiers France

Laboratory of Pharmaceutical Microbiology Ghent University Ghent Belgium

Microbial Biofilm Laboratory IRCCS Fondazione Santa Lucia Rome Italy

Servicio de Microbiología Hospital Universitario Son Espases Instituto de Investigación Sanitaria de Palma Palma de Mallorca Spain

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