Symposia

CHALMERS J. LYONS MEMORIAL LECTURE

Presented on Thursday, September 11, 1:00 pm2:30 pm

The Role of Biofilms in Device-Related

and Other Chronic Bacterial Infections
John William Costerton, PhD, Bozeman, MT
The systematic examination of devices and tissues
removed from device-related and other chronic bacterial
and fungal infections has revealed that the organisms
that cause these very refractory infections actually grow
in matrix-enclosed biofilms. The refractory nature of
these infections is now explained in terms of the inherent resistance of all biofilms to antibiotics, and other
antibacterial agents, and to host defense mechanisms
(antibodies and phagocytes) that normally resolve acute
infections caused by planktonic (floating) bacteria.
If we consider that all device-related infections have
this peculiar etiology, as well as many other chronic
infections (eg, otitis media, prostatitis), current estimates of the proportion of these biofilm infections seen
by physicians in the developed world range from 65% to
80%. These biofilm infections are generally characterized
by their slow development, their refractory response to
therapy, their generation of repeated acute exacerbations (which do respond to therapy), and the necessity
of the removal of the device and/or of affected tissue in
order to effect a cure.
If we harness the new concepts of biofilm science and
engineering in the struggle against device-related infections, there are many advantages to be gained. We know
that biofilm formation is favored by residues of dead biofilm
on surfaces, so we know that biomaterials must be scrupulously cleaned before they are implanted. We know that

biofilm cells grow only very poorly, when they are recovered from surfaces and dispersed on agar plates, so we
know that many culture negative presentations are actually low grade biofilm infections. We know that acute
exacerbations may respond to antibiotic therapy, but that
true biofilm cells are not killed, so we know that colonized
devices and affected tissues must be removed before device-related infections can be resolved. We know that both
ultrasonic energy and DC electric fields can reduce the
resistance of biofilm cells to that of planktonic cells, so we
can invoke their use in the treatment of chronic infections.
We know that cells in biofilms express a profoundly different phenotype from that expressed by planktonic cells, so
we are now targeting biofilm-specific genes with new
agents that will kill these matrix-enclosed organisms. We
have discovered that the process of biofilm formation is
controlled by simple chemical signals, and that analogues
of these compounds can be used to inhibit biofilm formation, and even to induce the detachment of preformed
biofilms from surfaces. The application of these concepts
to the problem of device-related infections shows great
promise, and we propose clinical testing of several antibiofilm strategies.
References
Cook G, Costerton JW, Darouiche RO: Direct confocal microscopy
studies of the bacterial colonization in vitro of a silver-coated heart
valve sewing cuff. Int J Antimicrobial Agents 13:169, 2000
Costerton JW, Stewart PS, Greenberg EP: Bacterial biofilms: A common cause of persistent infections. Science 284:1318, 1999
Costerton JW, Stewart PS: Battling Biofilms. Scientific American
285:75, 2001

SYMPOSIUM ON ADVANCES IN MAXILLARY RECONSTRUCTION

Presented on Thursday, September 11, 3:00 pm5:45 pm
Moderator: George Sandor, MD, DDS, PhD, FRCD(C), FRCS(C), FACS, Toronto, Ontario, Canada

Whats Wrong With an Obturator Anyway?

James Anderson, DDS, Toronto, Ontario, Canada
In a relatively short time, postoperative management
of maxillectomy patients has progressed from no management at all, to near-complete restoration of tissue
integrity and function. The range of treatment options
has greatly expanded with the development of new local
and free flap designs, new bone management techniques, and new implant designs.
With the arrival of new options comes the temptation
to apply them to as many situations as possible. This
temptation can be driven not only by the newness of the
10

latest treatment option but also by the intuitive urge to

regain preoperative anatomic integrity and the best possible function. However, the social, functional, psychological, and financial needs and values of the patient may
have much greater impact on the treatment planning
decisions than mere restoration of tissue contour. In
other words, because a more elegant procedure has
been shown to produce clinical results closer to preoperative tissue contour and better function, this is not
sufficient reason to apply it in most or even any patients.
The risk, morbidity, cost, and any other subjective considerations may render newly available techniques inappropriate. Treatment planners must focus on the patients perceived needs.
AAOMS 2003