Targeting biofilms in medical devices using probiotic cells: a systematic review

Biofilm-related infections are becoming a major clinical problem due to the increasingly widespread ability of pathogens to develop persistent biofilms in medical devices. The inadequate response of conventional antimicrobial strategies to counteract biofilm development demands urgent alternatives. An increasing interest in promoting a natural approach to health has intensified the research in the field of probiotics to battle pathogenic biofilms. This study aims to summarize the recent evidence supporting the effects of probiotic cells on the control and prevention of medical device-associated biofilms using a PRISMA-oriented (Preferred Reporting Items for Systematic reviews and Meta-Analyses) systematic search. This review demonstrated that probiotic cells have the potential to be used as biocontrol agents against biofilm formation by a broad spectrum of microorganisms. The restriction of biofilm growth caused by probiotics seemed to be strain-specific and independent of the antibiofilm strategy used (displacement, exclusion or competition). Lactobacillus, Lactococcus and Streptococcus were the most studied genus of probiotics and those with the higher capability to hinder biofilm formation, causing reductions up to 99.9%. These findings will pave the way to further experiments on the topic so that probiotic cells may become part of the clinical arsenal for the prevention and treatment of medical device-associated infections.This is a publication with acknowledgments to SurfSAFE. Corresponding author: Luciana C. Gomes, email: luciana.gomes@fe.up.p