Modality of bacterial growth presents unique targets: How do we treat biofilm-mediated infections?

It is well accepted that bacterial pathogens growing in a biofilm are recalcitrant to the action of most antibiotics and are resistant to the innate immune system. New treatment modalities are greatly warranted to effectively eradicate these infections. However, bacteria growing in a biofilm are metabolically unique in comparison to the bacteria growing in a planktonic state. Unfortunately, most antibiotics have been developed to inhibit the growth of bacteria in a planktonic mode of growth. This review focuses on the metabolism and physiology of biofilm growth with special emphasis on staphylococci. Future treatment options should include targeting unique metabolic niches found within bacterial biofilms in addition to the enzymes or compounds that inhibit biofilm accumulation molecules and/or interact with quorum sensing and intercellular bacterial communication.