Bacteria growing in biofilms cause a wide range of human infections. Biofilm bacteria are resistant to antimicrobics at levels 500 to 5,000 times higher than those needed to kill non-biofilm bacteria. In vitro experiments have shown that electric current can enhance the activity of some antimicrobial agents against certain bacteria in biofilms; this has been termed the “bioelectric effect”. Direct electrical current has already been safely used in humans for fracture healing. Application of direct electric current with antimicrobial chemotherapy in humans could theoretically abrogate the need to remove the device in device-related infections, a procedure associated with substantial morbidity and cost. In this article, we review what has been described in the literature with regards to the bioelectric effect. (Int J Artif Organs 2008; 31: 786–95)
del PozoJ.L., PatelR.The challenge of treating biofilm-associated bacterial infections. Clin Pharmacol Ther2007; 82: 204–9.
3.
LewisK.Riddle of biofilm resistance. Antimicrob Agents Chemother2001; 45: 999–1007.
4.
AnderlJ.N., FranklinM.J., StewartP.S.Role of antibiotic penetration limitation in Klebsiella pneumoniae biofilm resistance to ampicillin and ciprofloxacin. Antimicrob Agents Chemother2000; 44: 1818–24.
5.
AnwarH., DasguptaM.K., CostertonJ.W.Testing the susceptibility of bacteria in biofilms to antibacterial agents. Antimicrob Agents Chemother1990; 34: 2043–6.
6.
CostertonJ.W., ChengK.J., GeeseyG.G., LaddT.I., NickelJ.C., DasguptaM.Bacterial biofilms in nature and disease. Annu Rev Microbiol1987; 41: 435–64.
SabelnikovA.G., CymbalyukE.S., GongadzeG., BorovyaginV.L.Escherichia coli membranes during electrotransformation: an electron microscopy study. Biochim Biophys Acta1991; 1066: 21–8.
9.
RajnicekA.M.Bacterial galvanotropism: mechanisms and applications. Sci Prog1993; 77(Pt 1–2): 139–51.
10.
PareilleuxA., SicardN.Lethal effects of electric current on Escherichia coli. Appl Microbiol1970; 19: 421–4.
11.
BarrancoS.D., SpadaroJ.A., BergerT.J., BeckerR.O.In vitro effect of weak direct current on Staphylococcus aureus. Clin Orthop Relat Res1974; 100: 250–5.
DavisC.P., WagleN., AndersonM.D., WarrenM.M.Bacterial and fungal killing by iontophoresis with long-lived electrodes. Antimicrob Agents Chemother1991; 35: 2131–4.
14.
MatsunagaT., NakasonoS., MasudaS.Electrochemical sterilization of bacteria absorbed on granular activated carbon. FEMS Microbiol Lett1992; 72: 255–9.
15.
MatsunagaT., NakasonoS., TakamukuT., BurgessJ.G., NakamuraN., SodeK.Disinfection of drinking water by using a novel electrochemical reactor employing carbon-cloth electrodes. Appl Environ Microbiol1992; 58: 686–9.
16.
DavisC.P., ShirtliffM.E., TrieffN.M., HoskinsS.L., WarrenM.M.Quantification, qualification, and microbial killing efficiencies of antimicrobial chlorine-based substances produced by iontophoresis. Antimicrob Agents Chemother1994; 38: 2768–74.
17.
BlenkinsoppS.A., KhouryA.E., CostertonJ.W.Electrical enhancement of biocide efficacy against Pseudomonas aeruginosa biofilms. Appl Environ Microbiol1992; 58: 3770–3.
18.
KhouryA.E., LamK., EllisB., CostertonJ.W.Prevention and control of bacterial infections associated with medical devices. ASAIO J1992; 38: M174–8.
19.
CostertonJ.W., EllisB., LamK., JohnsonF., KhouryA.E.Mechanism of electrical enhancement of efficacy of antibiotics in killing biofilm bacteria. Antimicrob Agents Chemother1994; 38: 2803–9.
20.
JassJ., Lappin-ScottH.M.The efficacy of antibiotics enhanced by electrical currents against Pseudomonas aeruginosa biofilms. J Antimicrob Chemother1996; 38: 987–1000.
21.
WellmanN., FortunS.M., McLeodB.R.Bacterial biofilms and the bioelectric effect. Antimicrob Agents Chemother1996; 40: 2012–4.
22.
JassJ., CostertonJ.W., Lappin-ScottH.M.The effect of electrical currents and tobramycin on Pseudomonas aeruginosa biofilms. J Ind Microbiol1995; 15: 234–42.
23.
StewartP.S., WattanakaroonW., GoodrumL., FortunS.M., McLeodB.R.Electrolytic generation of oxygen partially explains electrical enhancement of tobramycin efficacy against Pseudomonas aeruginosa biofilm. Antimicrob Agents Chemother1999; 43: 292–6.
24.
StoodleyP., deBeerD., Lappin-ScottH.M.Influence of electric fields and pH on biofilm structure as related to the bioelectric effect. Antimicrob Agents Chemother1997; 41: 1876–9.
25.
EllwoodD.C., KeevilC.W., MarshP.D., BrownC.M., WardellJ.N.Surface-associated growth. Philos Trans R Soc Lond A1982; 297: 517–32.
26.
AnderlJ.N., ZahllerJ., RoeF., StewartP.S.Role of nutrient limitation and stationary-phase existence in Klebsiella pneumoniae biofilm resistance to ampicillin and ciprofloxacin. Antimicrob Agents Chemother2003; 47: 1251–6.
27.
BorrielloG., WernerE., RoeF., KimA.M., EhrlichG.D., StewartP.S.Oxygen limitation contributes to antibiotic tolerance of Pseudomonas aeruginosa in biofilms. Antimicrob Agents Chemother2004; 48: 2659–64.
28.
McLeodB.R., FortunS., CostertonJ.W., StewartP.S.Enhanced bacterial biofilm control using electromagnetic fields in combination with antibiotics. Methods Enzymol1999; 310: 656–70.
29.
WattanakaroonW., StewartP.S.Electrical enhancement of Streptococcus gordonii biofilm killing by gentamicin. Arch Oral Biol2000; 45: 167–71.
30.
PickeringS.A., BaystonR., ScammellB.E.Electromagnetic augmentation of antibiotic efficacy in infection of orthopaedic implants. J Bone Joint Surg2003; 85: 588–93.
31.
CaubetR., Pedarros-CaubetF., ChuM., FreyeE., de Belem RodriguesM., MoreauJ.M.A radio frequency electric current enhances antibiotic efficacy against bacterial biofilms. Antimicrob Agents Chemother2004; 48: 4662–4.
32.
del PozoJ.L., RouseM.S., NguyenG., SteckelbergJ.M., PatelR.The effect of electrical current on antimicrobial activity against methicillin resistant Staphylococcus aureus (MRSA) biofilms. 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), September 2007, Chicago IL, USA.
33.
del PozoJ.L., RouseM.S., Fernandez-SampedroM., SteckelbergJ.M., PatelR.Electrode composition and electrical enhancement of rifampin activity against methicillin resistant Staphylococcus aureus (MRSA) biofilms. 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) September 2007, Chicago IL, USA.
34.
DavisC.P., AndersonM.D., HoskinsS., WarrenM.M.Electrode and bacterial survival with iontophoresis in synthetic urine. J Urol1992; 147: 1310–3.
35.
DavisC.P., WagleN., AndersonM.D., WarrenM.M.Iontophoresis generates an antimicrobial effect that remains after iontophoresis ceases. Antimicrob Agents Chemother1992; 36: 2552–5.
36.
DavisC.P., WeinbergS., AndersonM.D., RaoG.M., WarrenM.M.Effects of microamperage, medium, and bacterial concentration on iontophoretic killing of bacteria in fluid. Antimicrob Agents Chemother1989; 33: 442–7.
37.
JuckerB.A., HarmsH., ZehnderA.J.Adhesion of the positively charged bacterium Stenotrophomonas (Xanthomonas) maltophilia 70401 to glass and Teflon. J Bacteriol1996; 178: 5472–9.
38.
PoortingaA.T., BosR., BusscherH.J.Controlled electrophoretic deposition of bacteria to surfaces for the design of biofilms. Biotechnol Bioeng2000; 67: 117–20.
39.
UeshimaM., TanakaS., NakamuraS., YamashitaK.Manipulation of bacterial adhesion and proliferation by surface charges of electrically polarized hydroxyapatite. J Biomed Mater Res2002; 60: 578–84.
40.
van der BordenA.J., van der MeiH.C., BusscherH.J.Electric-current-induced detachment of Staphylococcus epidermidis strains from surgical stainless steel. J Biomed Mater Res2004; 68: 160–4.
41.
van der BordenA.J., van der WerfH., van der MeiH.C., BusscherH.J.Electric current-induced detachment of Staphylococcus epidermidis biofilms from surgical stainless steel. Appl Environ Microbiol2004; 70: 6871–4.
42.
van der BordenA.J., MaathuisP.G., EngelsE., RakhorstG., van der MeiH.C., BusscherH.J.Prevention of pin tract infection in external stainless steel fixator frames using electric current in a goat model. Biomaterials2007; 28: 2122–6.
43.
SersaG., MiklavcicD.Inhibition of SA-1 tumor growth in mice by human leukocyte interferon alpha combined with low-level direct current. Mol Biother1990; 2: 165–8.
44.
BelehradekJ.Jr., OrlowskiS., RamirezL.H., PronG., PoddevinB., MirL.M.Electropermeabilization of cells in tissues assessed by the qualitative and quantitative electroloading of bleomycin. Biochim Biophys Acta1994; 23: 1190: 155–63.
