Clinical Outcomes of antimicrobial stewardship programs in Patients with biofilm-associated infection

Abstract

Background: Biofilm-associated infection, involving prosthetic joints, vascular catheters, and cardiac devices, routinely resists antibiotic regimens that succeed against the same organism growing planktonically, raising the question of whether generic antimicrobial stewardship programs serve this population as well as they serve infections without a biofilm component.

Objective: This review synthesizes the clinical outcomes literature on antimicrobial stewardship programs applied to patients with biofilm-associated infection, examining whether standard stewardship metrics track meaningful outcomes here and whether biofilm-specific protocol adaptation improves cure and reinfection rates.

Methods: We synthesized peer-reviewed clinical outcomes studies, systematic reviews and meta-analyses of stewardship program effectiveness, and society guideline documents for biofilm-associated device and implant infection.

Findings: General stewardship programs reliably reduce antimicrobial consumption, resistant-organism incidence, and C. difficile infection, but the smaller literature stratified by clinical outcome shows a weaker signal, and mature device-infection guidelines instead rely on prolonged, biofilm-active, often combination therapy with source control, a pattern at odds with duration- and de-escalation-focused stewardship defaults.

Conclusions: Extending stewardship's demonstrated benefits to biofilm-associated infection requires pathway-specific protocols audited on guideline concordance rather than generic targets, supported by laboratory infrastructure able to flag biofilm-relevant clinical context.