Eur J Clin Microbiol Infect Dis DOI 10.1007/s10096-014-2261-1
REVIEW
Role of biofilm in children with recurrent upper respiratory tract infections E. Nazzari & S. Torretta & L. Pignataro & P. Marchisio & S. Esposito
Received: 16 August 2014 / Accepted: 6 October 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Recurrent respiratory tract infections (RRTIs) are very common in children and a major challenge for pediatricians. In the last few years, bacterial biofilms have been linked to RRTIs and antibiotic resistance, and have raised serious concerns regarding the therapeutic management of recurrent middle ear diseases, chronic rhinosinusitis, and recurrent pharyngotonsillitis. This paper aims to review the new insights into biofilm-related upper respiratory tract infections in children and possible therapeutic strategies. It focuses on the clinical implications for recurrent disease and on studies in pediatric patients. Analysis of the literature showed that the involvement of bacterial biofilm in recurrent upper airway tract infections is an emerging problem that may lead to serious concerns about infection control. Despite the large amount of research within this field, detailed insight into the complex structure of bacterial biofilms and the ultrastructural and biochemical mechanisms responsible for its evasion of the immune system and resistance to treatments is currently lacking. In the future, additional emphasis should be placed on biofilm management as a component of therapeutic strategies. This goal can be attained by finding feasible methods for detecting biofilms in vivo and identifying effective methods for administering treatments that eradicate preexisting bacterial biofilms or hinder bacterial adhesion to respiratory cells.
E. Nazzari : P. Marchisio : S. Esposito (*) Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda no. 9, 20122 Milan, Italy e-mail: [email protected] S. Torretta : L. Pignataro Otorhinolaryngology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Introduction Recurrent respiratory tract infections (RRTIs) are very common in children and are a major challenge for pediatricians. The most widely accepted definition of RRTI includes the absence of any underlying pathological condition that may justify the recurrence of infection and a diagnosis of eight or more illnesses due to respiratory infections per year in children aged up to 3 years, or six or more per year in those aged more than 3 years [1]. Studies have shown that the criteria change in the case of recurrent infections affecting the same site: the definitions of recurrent acute otitis media (RAOM) and recurrent rhinosinusitis specify three episodes within 6 months or four episodes within 12 months, while a diagnosis of recurrent pharyngotonsillitis requires six episodes within 12 months [2–4]. In developed countries, RRTIs affect up to 25 % of children aged
REVIEW
Role of biofilm in children with recurrent upper respiratory tract infections E. Nazzari & S. Torretta & L. Pignataro & P. Marchisio & S. Esposito
Received: 16 August 2014 / Accepted: 6 October 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Recurrent respiratory tract infections (RRTIs) are very common in children and a major challenge for pediatricians. In the last few years, bacterial biofilms have been linked to RRTIs and antibiotic resistance, and have raised serious concerns regarding the therapeutic management of recurrent middle ear diseases, chronic rhinosinusitis, and recurrent pharyngotonsillitis. This paper aims to review the new insights into biofilm-related upper respiratory tract infections in children and possible therapeutic strategies. It focuses on the clinical implications for recurrent disease and on studies in pediatric patients. Analysis of the literature showed that the involvement of bacterial biofilm in recurrent upper airway tract infections is an emerging problem that may lead to serious concerns about infection control. Despite the large amount of research within this field, detailed insight into the complex structure of bacterial biofilms and the ultrastructural and biochemical mechanisms responsible for its evasion of the immune system and resistance to treatments is currently lacking. In the future, additional emphasis should be placed on biofilm management as a component of therapeutic strategies. This goal can be attained by finding feasible methods for detecting biofilms in vivo and identifying effective methods for administering treatments that eradicate preexisting bacterial biofilms or hinder bacterial adhesion to respiratory cells.
E. Nazzari : P. Marchisio : S. Esposito (*) Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda no. 9, 20122 Milan, Italy e-mail: [email protected] S. Torretta : L. Pignataro Otorhinolaryngology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Introduction Recurrent respiratory tract infections (RRTIs) are very common in children and are a major challenge for pediatricians. The most widely accepted definition of RRTI includes the absence of any underlying pathological condition that may justify the recurrence of infection and a diagnosis of eight or more illnesses due to respiratory infections per year in children aged up to 3 years, or six or more per year in those aged more than 3 years [1]. Studies have shown that the criteria change in the case of recurrent infections affecting the same site: the definitions of recurrent acute otitis media (RAOM) and recurrent rhinosinusitis specify three episodes within 6 months or four episodes within 12 months, while a diagnosis of recurrent pharyngotonsillitis requires six episodes within 12 months [2–4]. In developed countries, RRTIs affect up to 25 % of children aged
