The role of Biofilms in the disease process and chronicity of Rhinosinusitis has been evaluated and suggested by many researchers but its role in the resistance to antimicrobials and chronicity of the disease is still under evaluation. Hence taking intoconsideration the above fact a Prospective study was undertaken to evaluate the role of biofilms in the chronicity and resistance in patients of Chronic Rhinosinusitis.

Materials and Methods: Patients were divided into two groups cases (as per the Rhinosinusitis Task Force Criteria of 1993 and its amendment in 2006) and controls. Nasal swabs were taken and were sent for culture and sensitivity. The specimens in which growth of organism was identified were further subjected to test their ability to form biofilms.

Results: Methicillin Resistant Staphylococcus aureus (MRSA) was found to be the most common organism isolated, A higher percentage of biofilm forming organisms were present amongst the cases as compared to controls rendering a p-value of 0.00001124, which is highly significant, the isolates from cases were sensitive to higher order antibiotics as compared to controls and also showed a higher degree of antimicrobial resistance.

Conclusion: Through this study we conclude that there is a definite role of Biofilms in chronicity and antimicrobial resistance amongst organisms which are the causative agents of Chronic Rhinosinusitis.

Keywords: biofilms, chronic rhinosinusitis, staphylococcus aureus, antimicrobial resistance.

1. Harvey RJ, Lund VJ. Biofilms and chronic rhinosinusitis: systematic review of evidence, current concepts and directions for research. Rhinology. 2007 Mar;45(1): 3-13. Review.
2. Foreman A, Holtappels G, Psaltis AJ, et al: Adaptive immune responses in Staphylo-coccus aureus biofilm-associated chronic rhinosinusitis. Allergy 66(11):1449–1456, 2011.
3. Costerton, J.W., G.G. Geesey, and K.J. Cheng. How bacteria stick. Sci Am 1978; 238. (1): 86-95.
4. Donlan, R.M. and J.W. Costerton. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev 2002; 15 (2): p. 167-193.
5. Korber, D.R., J.R. Lawrence, H.M. Lappin-Scott, and J.W. Costerton, Growth of microorganisms on surfaces. In Microbial Biofilms, ed. H.M. Lappin-Scott and J.W. Costerton. 1995, Cambridge, UK:: Cambridge Univ. Press. 15-45.
6. O'Toole, G.A. and R. Kolter. Flagellar and twitching motility are necessary for Pseu-domonas aeruginosa biofilm development. Mol Microbiol 1998; 30 (2): 295- 304.
7. Heydorn, A., A.T. Nielsen, M. Hentzer, C. Sternberg, M. Givskov, B.K. Ersboll, and S. Molin. Quantification of biofilm structures by the novel computer program COMSTAT. Microbiology 2000; 146 : 2395-2407.
8. Tolker-Nielsen, T., U.C. Brinch, P.C. Ragas, J.B. Andersen, C.S. Jacobsen, and S. Molin. Development and dynamics of Pseudomonas sp. biofilms. J Bacteriol 2000; 182 (22): 6482-6489.
9. Luppens, S.B., M.W. Reij, R.W. van der Heijden, F.M. Rombouts, and T. Abee. Development of a standard test to assess the resistance of Staphylococcus aureus biofilm cells to disinfectants. Appl Environ Microbiol 2002; 68 (9): 4194-4200.
10. Ceri, H., M.E. Olson, C. Stremick, R.R. Read, D. Morck, and A. Buret. The Calgary Biofilm Device: new technology for rapid determination of antibiotic susceptibilities of bacterial biofilms. J ClinMicrobiol 1999; 37 (6): 1771-1776.
11. Hoyle, B.D. and J.W. Costerton. Bacterial resistance to antibiotics: the role of biofilms. Prog Drug Res 1991; 37: 91-105.
12. Anderl, J.N., M.J. Franklin, and P.S. Stewart. Role of antibiotic penetration limitation in Klebsiella pneumoniae biofilm resistance to ampicillin and ciprofloxacin. Antimicrob Agents Chemother 2000; 44 (7): 1818-1824.
13. Jouenne, T., O. Tresse, and G.A. Junter. Agar-entrapped bacteria as an in vitro model of biofilms and their susceptibility to antibiotics. FEMS Microbiol Lett 1994; 119 (1- 2): 237-242.
14. Dunne, W.M., Jr., E.O. Mason, Jr., and S.L. Kaplan. Diffusion of rifampin and vancomycin through a Staphylococcus epidermidis biofilm. Antimicrob Agents Chemother 1993; 37 (12): 2522-2526.
15. Yasuda, H., Y. Ajiki, T. Koga, and T. Yokota. Interaction between clarithromycin and biofilms formed by Staphylococcus epidermidis. Antimicrob Agents Chemother 1994; 38 (1): 138-141.
16. Suci, P.A., M.W. Mittelman, F.P. Yu, and G.G. Geesey. Investigation of ciproflo-xacin penetration into Pseudomonas aeruginosa biofilms. Antimicrob Agents Chemother 1994; 38 (9): 2125-2133.
17. Yasuda, H., Y. Ajiki, T. Koga, H. Kawada, and T. Yokota. Interaction between biofilms formed by Pseudomonas aeruginosa and clarithromycin. Antimicrob Agents Chemother 1993; 37 (9): 1749-1755.
18. Shigeta, M., G. Tanaka, H. Komatsuzawa, M. Sugai, H. Suginaka, and T. Usui. Permeation of antimicrobial agents through Pseudomonas aeruginosa biofilms: a simple method. Chemotherapy 1997; 43 (5): 340-345.
19. Kumon, H., K. Tomochika, T. Matunaga, M. Ogawa, and H. Ohmori. A sandwich cup method for the penetration assay of antimicrobial agents through Pseudomonas exopolysaccharides. Microbiol Immunol 1994; 38 (8): 615-619.
20. Nichols, W.W., M.J. Evans, M.P. Slack, and H.L. Walmsley. The penetration of antibiotics into aggregates of mucoid and non-mucoid Pseudomonas aeruginosa. J Gen Microbiol 1989; 135 (5): 1291-1303.
21. Walters, M.C., 3rd, F. Roe, A. Bugnicourt, M.J. Franklin, and P.S. Stewart. Contributions of antibiotic penetration, oxygen limitation, and low metabolic activity to tolerance of Pseudomonas aeruginosa biofilms to ciprofloxacin and tobramycin. Antimicrob Agents Chemother 2003; 47 (1): 317-323.
22. Gordon, C.A., N.A. Hodges, and C. Marriott. Antibiotic interaction and diffusion through alginate and exopolysac-charide of cystic fibrosis-derived Pseudomonas aeruginosa. J Antimicrob Chemother 1988; 22 (5): 667-674.
23. Giwercman, B., E.T. Jensen, N. Hoiby, A. Kharazmi, and J.W. Costerton. Induction of beta-lactamase production in Pseudomonas aeruginosa biofilm. Antimicrob Agents Chemother 1991; 35 (5): 1008-1010.
24. Anderl, J.N., J. Zahller, F. Roe, and P.S. Stewart. Role of nutrient limitation and stationary-phase existence in Klebsiella pneumoniae biofilm resistance to ampicillin and ciprofloxacin. Antimicrob Agents Chemother 2003; 47 (4): 1251-1256.
25. Farber, B.F., M.H. Kaplan, and A.G. Clogston. Staphylococcus epidermidis extracted slime inhibits the antimicrobial action of glycopeptide antibiotics. J Infect Dis 1990; 161 (1): 37-40.
26. Konig, C., S. Schwank, and J. Blaser. Factors compromising antibiotic activity against biofilms of Staphylococcus epidermidis. Eur J ClinMicrobiol Infect Dis 2001; 20 (1): 20-26.
27. Souli, M. and H. Giamarellou. Effects of slime produced by clinical isolates of coagulase-negative staphylococci on activities of various antimicrobial agents. Antimicrob Agents Chemother 1998; 42 (4): 939-941.
28. Wimmpenny, J.W.T. and S.L. Kinniment, Biochenical reactions and the establishment of gradients within biofilms. Microbial iofilms, ed. H.M. Lappin-Scott and J.W. Costerton. 1995, Cambridge: Cambridge University Press. 99-117.
29. Tack, K.J. and L.D. Sabath. Increased minimum inhibitory concentrations with anaerobiasis for tobramycin, gentamicin, and amikacin, compared to latamoxef, piperacillin, chloramphenicol, and clindamycin. Chemotherapy 1985; 31 (3): 204- 210.
30. Retsema, J.A., L.A. Brennan, and A.E. Girard. Effects of environmental factors on the in vitro potency of azithromycin. Eur J ClinMicrobiol Infect Dis 1991; 10 (10): 834-842.
31. Venglarcik, J.S., 3rd, L.L. Blair, and L.M. Dunkle. pH-dependent oxacillin tolerance of Staphylococcus aureus. Antimicrob Agents Chemother 1983; 23 (2): 232-235.
32. Wentland, E.J., P.S. Stewart, C.T. Huang, and G.A. McFeters. Spatial variations in growth rate within Klebsiella pneumoniae colonies and biofilm. Biotechnol Prog 1996; 12 (3): 316-321.
33. Sternberg, C., B.B. Christensen, T. Johansen, A. Toftgaard Nielsen, J.B. Andersen, M. Givskov, and S. Molin. Distribution of bacterial growth activity in flow-chamber biofilms. Appl Environ Microbiol 1999; 65 (9): 4108-4117.
34. Xu, K.D., P.S. Stewart, F. Xia, C.T. Huang, and G.A. McFeters. Spatial physiological heterogeneity in Pseudo-monas aeruginosa biofilm is determined by oxygen availability. Appl Environ Microbiol 1998; 64 (10): 4035-4039.
35. Costerton, J.W., P.S. Stewart, and E.P. Greenberg. Bacterial biofilms: a common cause of persistent infections. Science 1999; 284 (5418): 1318-1322.
36. Brooun, A., S. Liu, and K. Lewis. A dose-response study of antibiotic resistance in Pseudomonas aeruginosa biofilms. Antimicrob Agents Chemother 2000; 44 (3): 640-646.
37. Mah, T.F., B. Pitts, B. Pellock, G.C. Walker, P.S. Stewart, and G.A. O'Toole. A genetic basis for Pseudomonas aeruginosa biofilm antibiotic resistance. Nature 2003; 426 (6964): 306-310.
38. Espinosa-Urgel, M., A. Salido, and J.L. Ramos. Genetic analysis of functions involved in adhesion of Pseudomonas putida to seeds. J Bacteriol 2000; 182 (9): 2363-2369.

Lakshmi Narayan Garg

Professor Department of E.N.T,

M.M.Institute of Medical Sciences and Research, Ambala, Haryana 13320

Email: This email address is being protected from spambots. You need JavaScript enabled to view it. +91-9896320022