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Iqbal K, Rohde H, Huang J, Tikiso T, Amann LF, Zeitlinger M, Wicha SG. A pharmacokinetic-pharmacodynamic (PKPD) model-based analysis of tedizolid against enterococci using the hollow-fibre infection model. J Antimicrob Chemother 2022; 77:2470-2478. [PMID: 35696407 DOI: 10.1093/jac/dkac183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/14/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Tedizolid is a novel oxazolidinone antibiotic. Considering the higher antibacterial effect in immunocompetent compared with immunosuppressed animals, it is not recommended in immunocompromised patients. OBJECTIVES In this study, we assessed the 'pure' pharmacokinetic-pharmacodynamic (PKPD) relationship for tedizolid against Enterococcus in the hollow-fibre infection model (HFIM). METHODS Unbound plasma concentration time profiles (200-5000 mg/day IV) were simulated in the HFIM over 120 h against an Enterococcus faecalis strain and two clinical isolates of Enterococcus faecium (VRE-vanB and VRE-vanA). Next, a PKPD model describing tedizolid efficacy against bacterial isolates was developed. A population PK model was linked to the developed PKPD model and utilized to predict the bacterial kinetics in plasma and in target tissues [adipose, muscle, epithelial lining fluid (ELF) and sputum] over 120 h of therapy. RESULTS The PKPD model adequately described the bacterial kill kinetics for all bacterial populations. At the human recommended dose of 200 mg/day, bacterial growth was predicted in plasma and all tissues, except for ELF. Bacteriostasis was observed only at a higher dose of 1200 mg/day over 120 h. An fAUC/MIC of 80 related to stasis over 120 h. Subpopulations resistant to 3 × MIC were amplified in plasma and target tissues, except for ELF, at doses of 200-800 mg/day. CONCLUSIONS The human dose of 200 mg/day was insufficient to suppress bacterial growth in the HFIM, indicating that further components contribute to the clinical effect of tedizolid. This study supports the warning/precaution for tedizolid to limit its use in immunocompromised patients.
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Ntalos D, Schoof B, Thiesen DM, Viezens L, Kleinertz H, Rohde H, Both A, Luebke A, Strahl A, Dreimann M, Stangenberg M. Implementation of a multidisciplinary infections conference improves the treatment of spondylodiscitis. Sci Rep 2021; 11:9515. [PMID: 33947939 PMCID: PMC8096947 DOI: 10.1038/s41598-021-89088-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 04/19/2021] [Indexed: 12/17/2022] Open
Abstract
Establishing a multidisciplinary approach regarding the treatment of spondylodiscitis and analyzing its effect compared to a single discipline approach. 361 patients diagnosed with spondylodiscitis were included in this retrospective pre-post intervention study. The treatment strategy was either established by a single discipline approach (n = 149, year 2003–2011) or by a weekly multidisciplinary infections conference (n = 212, year 2013–2018) consisting of at least an orthopedic surgeon, medical microbiologist, infectious disease specialist and pathologist. Recorded data included the surgical and antibiotic strategy, complications leading to operative revision, recovered microorganisms, as well as the total length of hospital and intensive care unit stay. Compared to a single discipline approach, performing the multidisciplinary infections conference led to significant changes in anti-infective and surgical treatment strategies. Patients discussed in the conference showed significantly reduced days of total antibiotic treatment (66 ± 31 vs 104 ± 31, p < 0.001). Moreover, one stage procedures and open transpedicular screw placement were more frequently performed following multidisciplinary discussions, while there were less involved spinal segments in terms of internal fixation as well as an increased use of intervertebral cages instead of autologous bone graft (p < 0.001). Staphylococcus aureus and Staphylococcus epidermidis were the most frequently recovered organisms in both patient groups. No significant difference was found comparing inpatient complications between the two groups or the total in-hospital stay. Implementation of a weekly infections conference is an effective approach to introduce multidisciplinarity into spondylodiscitis management. These conferences significantly altered the treatment plan compared to a single discipline approach. Therefore, we highly recommend the implementation to optimize treatment modalities for patients.
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Kietzerow J, Otto B, Wilke N, Rohde H, Iwersen-Bergmann S, Andresen-Streichert H. The challenge of post-mortem GHB analysis: storage conditions and specimen types are both important. Int J Legal Med 2019; 134:205-215. [PMID: 31598775 DOI: 10.1007/s00414-019-02150-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/20/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND For the interpretation of concentrations of gamma-hydroxybutyrate (GHB) in post-mortem specimens, a possible increase due to post-mortem generation in the body and in vitro has to be considered. The influence of different storage conditions and the specimen type was investigated. METHOD AND MATERIAL Post-mortem GHB concentrations in femoral venous blood (VB), heart blood (HB), serum (S) from VB, urine (U), cerebrospinal fluid (CSF) and vitreous humour (VH) were determined by gas chromatography-mass spectrometry after derivatisation. Various storage conditions, that is 4 °C or room temperature (RT) and the addition of sodium fluoride (NaF), were compared during storage up to 30 days. Additionally, bacterial colonisation was determined by mass spectrometry fingerprinting. RESULTS Twenty-six cases without involvement of exogenous GHB were examined. GHB concentrations (by specimen) at day 0 were 3.9-22.1 mg/L (VB), 6.6-33.3 mg/L (HB), < 0.5-18.1 mg/L (U), 1.1-10.4 mg/L (CSF) and 1.7-22.0 mg/L (VH). At 4 °C, concentrations increased at day 30 to 5.6-74.5 mg/L (VB), 4.6-76.5 mg/L (HB) and < 0.5-21.3 mg/L (U). At RT, concentrations rose to < 0.5-38.5 mg/L (VB), 1.2-94.6 mg/L (HB) and < 0.5-37.5 mg/L (U) at day 30. In CSF, at RT, an increase up to < 0.5-21.2 mg/L was measured, and at 4 °C, a decrease occurred (< 0.5-6.5 mg/L). GHB concentrations in VH remained stable at both temperatures (1.2-20.9 mg/L and < 0.5-26.2 mg/L). The increase of GHB in HB samples with NaF was significantly lower than that without preservation. No correlation was found between the bacterial colonisation and extent of GHB concentration changes. CONCLUSION GHB concentrations can significantly increase in post-mortem HB, VB and U samples, depending on storage time, temperature and inter-individual differences. Results in CSF, VH, S and/or specimens with NaF are less affected.
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Ntalos D, Berger-Groch J, Rohde H, Grossterlinden LG, Both A, Luebke A, Hartel MJ, Klatte TO. Implementation of a multidisciplinary infections conference affects the treatment plan in prosthetic joint infections of the hip: a retrospective study. Arch Orthop Trauma Surg 2019; 139:467-473. [PMID: 30488282 DOI: 10.1007/s00402-018-3079-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Establishing a systematic multidisciplinary approach in the treatment of prosthetic joint infections (PJI) of the hip and analyzing its effect on clinical decision-making. PATIENTS AND METHODS Forty-six patients diagnosed with PJI of the hip were included in the retrospective study. The treatment plan was either established by a single-discipline approach (n = 20) or by a weekly multidisciplinary infections conference (n = 26) consisting of at least an orthopedic surgeon, microbiologist and pathologist. Recorded data included the length of hospital stay, number and type of surgeries, medical complications, recovered organisms as well as the number of applied antibiotics. RESULTS Patients discussed in the multidisciplinary infections conference showed a significantly shorter in-hospital stay (29 vs 62 days; p < 0.05), a significant reduction in surgeries (1.8 vs 5.1; p < 0.05) and a smaller number of antibiotics required (2.8 vs 4.2; p < 0.05). No significant difference could be found comparing inpatient complications between the two groups. Staphylococcus aureus and coagulase-negative staphylococci were the most frequently recovered organisms in both patient groups. CONCLUSION This study demonstrates the successful implementation of a weekly infections conference as an instrument to introduce a multidisciplinary approach to PJI of the hip. Implementation of these conferences significantly improves the treatment plan compared to a single-discipline approach, which we therefore highly recommend for other institutions. Multidiscipline may even affect clinical outcome which needs to be further investigated.
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Knobloch KM, Von Osten H, Horstkotte MA, Rohde H, Mack D. Biofilm Formation is not Necessary for Development of Quinolone-Resistant “Persister” cells in an Attached Staphylococcus Epidermidis Population. Int J Artif Organs 2018; 31:752-60. [DOI: 10.1177/039139880803100902] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Staphylococcus epidermidis is a common pathogen in device-associated infections which is able to attach onto polymeric surfaces and develop multilayered biofilms. Attached S. epidermidis displays reduced susceptibility to antimicrobial agents. In this study we investigated the influence of ciprofloxacin and the group IV quinolones gatifloxacin, gemifloxacin, and moxifloxacin with the minimal attachment killing (MAK) assay. MAK concentrations were determined for three biofilm-positive wild-type strains and their isogenic biofilm-negative mutants Depending on strain and investigated quinolone, it was possible to distinguish between a heterogeneous MAK (MAKhetero), and a homogeneous resistance (MAKhomo) which corresponds to the model of a few persisting cells under antibiotic treatment. A lower MAKhomo was detected for the biofilm-negative mutants as well as for the corresponding wild-types for some of the tested quinolones, which seems to be a result of higher bacterial inocula, whereas the MAKhetero concentrations were comparable for mutants and wild-types for nearly all of the tested antibiotics and strains. These data indicate that biofilm formation is not necessary for persistence of attached S. epidermidis cells under treatment with quinolones and could explain therapeutic failure in foreign body-associated infections due to biofilm-negative S. epidermidis isolates. The individual resistance phenotypes of investigated strains indicate that the determination of MAK concentrations might help to predict the therapy outcome of foreign body-associated infections with both biofilm-positive and biofilm-negative S. epidermidis. Thus, the relatively high activity displayed by group IV quinolones against individual attached staphylococcal isolates indicates a possible treatment option with the respective quinolones for foreign body-associated infections due to these isolates. (Int J Artif Organs 2008; 31: 752–60)
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Bäsler K, Galliano M, Rohde H, Bessou-Touya S, Hélène D, Brandner J. 470 Epidermal tight junctions are strengthened by short-term staphylococcal challenge in an agr dependent manner. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maurer FP, Hentschke M, Rohde H. [Advances in diagnostic microbiology : Opportunities and limitations]. Med Klin Intensivmed Notfmed 2017; 112:199-205. [PMID: 28342095 DOI: 10.1007/s00063-017-0275-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 02/04/2023]
Abstract
In the light of ever increasing problems related to the emergence of multidrug-resistant bacteria, rapid microbiological diagnostics are of growing importance. Timely pathogen detection and availability of susceptibility data are essential for optimal treatment, but are even more crucial for de-escalation of broad spectrum empiric therapies. Medical microbiology is, thus, an integral part of antimicrobial stewardship programs. Traditional microbiological techniques for species identification and susceptibility testing rely on bacterial growth and are, thus, characterized by inherent slowness. Time-to-report is usually 48 h or longer, and typically delays optimization of therapeutic regimens. Constant improvement of available techniques (e. g., molecular methods) and introduction of novel methods (e. g., matrix-assisted laser desorption ionization time-of-flight [MALDI-ToF] mass spectrometry) have fundamentally changed diagnostic procedures. As a consequence, sensitivity and specificity as well as time-to-report have been dramatically improved. In this manuscript, key methodological advances in medical microbiology are discussed, emphasizing consequences for daily management of infectious disease patients.
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Christopeit M, Grundhoff A, Rohde H, Belmar-Campos C, Grzyska U, Fiehler J, Wolschke C, Ayuk F, Kröger N, Fischer N. Suspected encephalitis with Candida tropicalis and Fusarium detected by unbiased RNA sequencing. Ann Hematol 2016; 95:1919-21. [PMID: 27468852 DOI: 10.1007/s00277-016-2770-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/22/2016] [Indexed: 11/29/2022]
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Hollwitz B, Trillsch F, Hedinger N, Kiefmann R, Rohde H, Nierhaus A, Hecher K. Die Rückkehr der Mütter-Killer – zweiter schwerer, diesmal fataler Sepsis-Fall durch „second line“-Erreger binnen 2½ Jahren. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Clarke ADF, Elsner M, Rohde H. Can You Tell Me where Wally Is? Iperception 2013. [PMCID: PMC5393640 DOI: 10.1068/ig6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Rohde H, Levy R, Kehler A. Anticipating explanations in relative clause processing. Cognition 2011; 118:339-58. [PMID: 21216396 DOI: 10.1016/j.cognition.2010.10.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 10/20/2010] [Accepted: 10/22/2010] [Indexed: 11/26/2022]
Abstract
We show that comprehenders' expectations about upcoming discourse coherence relations influence the resolution of local structural ambiguity. We employ cases in which two clauses share both a syntactic relationship and a discourse relationship, and hence in which syntactic and discourse processing might be expected to interact. An off-line sentence-completion study and an on-line self-paced reading study examined readers' expectations for high/low relative-clause attachments following implicit-causality and non-implicit causality verbs (John detests/babysits the children of the musician who…). In the off-line study, the widely reported low-attachment preference for English is observed in the non-implicit causality condition, but this preference gives way to more high attachments in the implicit-causality condition in cases in which (i) the verb's causally implicated referent occupies the high-attachment position and (ii) the relative clause provides an explanation for the event described by the matrix clause (e.g., …who are arrogant and rude). In the on-line study, a similar preference for high attachment emerges in the implicit-causality context-crucially, before the occurrence of any linguistic evidence that the RC does in fact provide an explanation-whereas the low-attachment preference is consistent elsewhere. These findings constitute the first demonstration that expectations about ensuing discourse coherence relationships can elicit full reversals in syntactic attachment preferences, and that these discourse-level expectations can affect on-line disambiguation as rapidly as lexical and morphosyntactic cues.
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Harris L, Dudley E, Rohde H, Mack D. P07.09 Quorum sensing accessory gene regulator (agr)-specificity groups in Staphylococcus epidermidis from prosthetic joint and catheter infections. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ilchmann C, Zaiß NH, Speicher A, Christner M, Ackermann G, Rohde H. Comparison of resistance against erythromycin and moxifloxacin, presence of binary toxin gene and PCR ribotypes in Clostridium difficile isolates from 1990 and 2008. Eur J Clin Microbiol Infect Dis 2010; 29:1571-3. [DOI: 10.1007/s10096-010-1017-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 06/25/2010] [Indexed: 01/05/2023]
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Weiser J, Christner M, Rohde H, Singer D. Detektion und Identifikation von Bakterien anhand ihrer Wärmeabgabe: eine mikrokalorimetrische Untersuchung. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Weiser J, Christner M, Rohde H, Singer D. Beschleunigte Detektion von Katheterinfektionen mittels Mikrokalorimetrie: eine methodische Untersuchung. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schulze zur Wiesch J, Wichmann D, Sobottka I, Rohde H, Schmoock G, Wernery R, Schmiedel S, Dieter Burchard G, Melzer F. Genomic tandem repeat analysis proves laboratory-acquired brucellosis in veterinary (camel) diagnostic laboratory in the United Arab Emirates. Zoonoses Public Health 2009; 57:315-7. [PMID: 19925579 DOI: 10.1111/j.1863-2378.2009.01258.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a case of a 64-year-old veterinarian working in a state camel veterinary laboratory who was diagnosed with and treated for acute brucellosis with complicating epididymo-orchitis. Genomic tandem repeat analysis (MLVA-16) revealed identical Brucella strains in patient cultures and from different dromedary milk samples positive for Brucella melitensis, thereby confirming the diagnosis of a laboratory acquired infection. The case illustrates the high (airborne) infectivity of brucellosis in laboratory settings and the need to implement vigorous bio-safety measures in veterinary laboratories handling camel specimen diagnostic veterinary laboratory.
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Rohde H, Menzel M, Renz F, Filippou AC. Investigation of Mo- and W-stannylidyne complexes by Mössbauer spectroscopy. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10751-008-9821-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Saager B, Rohde H, Timmerbeil BS, Franke G, Pothmann W, Dahlke J, Scherpe S, Sobottka I, Heisig P, Horstkotte MA. Molecular characterisation of linezolid resistance in two vancomycin-resistant (VanB) Enterococcus faecium isolates using Pyrosequencing™. Eur J Clin Microbiol Infect Dis 2008; 27:873-8. [DOI: 10.1007/s10096-008-0514-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 03/25/2008] [Indexed: 11/29/2022]
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Rohde H. [Anal eczema, condylomata acuminata]. Dtsch Med Wochenschr 2008; 133:245-6. [PMID: 18236350 DOI: 10.1055/s-2008-1017504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Franke G, Dobinsky S, Mack D, Wang CJ, Sobottka I, Christner M, Knobloch JM, Horstkotte M, Aepfelbacher M, Rohde H. Expression and functional characterization of gfpmut3.1 and its unstable variants in Staphylococcus epidermidis. J Microbiol Methods 2007; 71:123-32. [DOI: 10.1016/j.mimet.2007.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 08/07/2007] [Accepted: 08/23/2007] [Indexed: 11/26/2022]
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Saager B, Horstkotte M, Rohde H, Sobottka I, Heisig P. P786 Susceptibility of Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis to daptomycin at a university medical centre Hamburg-Eppendorf, Germany. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70627-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Saager B, Horstkotte M, Rohde H, Sobottka I, Heisig P. P785 In vitro activitiy of dalbavancin against clinical vancomycin-resistant enterococci isolates. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70626-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rohde H. [Condylomata acuminata in the inner anal canal]. Dtsch Med Wochenschr 2007; 132:379-80. [PMID: 17299677 DOI: 10.1055/s-2007-970344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rohde H. Posttraumatisches, perianales Hämatom mit kleinem Epitheldefekt. Dtsch Med Wochenschr 2006. [DOI: 10.1055/s-2006-956294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mack D, Rohde H, Harris LG, Davies AP, Horstkotte MA, Knobloch JKM. Biofilm formation in medical device-related infection. Int J Artif Organs 2006; 29:343-59. [PMID: 16705603 DOI: 10.1177/039139880602900404] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medical device-associated infections, most frequently caused by coagulase-negative staphylococci, especially Staphylococcus epidermidis, are of increasing importance in modern medicine. Regularly, antimicrobial therapy fails without removal of the implanted device. The most important factor in the pathogenesis of medical device-associated staphylococcal infections is the formation of adherent, multilayered bacterial biofilms. There is urgent need for an increased understanding of the functional factors involved in biofilm formation, the regulation of their expression, and the interaction of those potential virulence factors in device related infection with the host. Significant progress has been made in recent years which may ultimately lead to new rational approaches for better preventive, therapeutic, and diagnostic measures.
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