背景:语音假体上的生物膜形成是其过早植入功能障碍的主要原因。在过去的几十年中,已经提出了多种策略来实现对这些装置上生物膜形成的抑制。这项研究的目的是评估硅橡胶语音假体上可用的体外生物膜抑制方式的结果。
方法:我们在PubMed中进行了系统的搜索,Embase,以及截至2020年2月29日的Cochrane中央对照试验登记册数据库。共有33项体外实验室研究调查了不同涂层方法对念珠菌的功效,葡萄球菌,链球菌,乳酸杆菌,包括硅橡胶医疗器械上的Rothia生物膜生长。进行了与预防方式类型相关的亚组分析,使用改良的CONSORT工具进行质量评估.
结果:来自33项研究的数据被纳入定性分析,其中12项具有定量分析资格。对于酵母生物膜形成评估,干预组有统计学显著差异(标准化平均差[SMD]=-1.20;95%置信区间[CI][-1.73,-0.66];p<0.0001).亚组分析表明,联合方法(主动和被动表面修饰)对酵母生物膜抑制最有效(SMD=-2.53;95%CI[-4.02,-1.03];p=0.00001)。在细菌生物膜抑制方面,干预组和对照组之间没有统计学上的显著差异(SMD=-0.09;95%CI[-0.68,0.46];p=0.65)。亚组分析的结果发现表面改性方法之间没有显着差异。在分析了微生物生物膜的数据后,与对照组相比,发现有利于预防方法的统计学差异(SMD=-2.59;95%CI[-7.48,2.31];p=0.30).
结论:关于生物膜抑制的荟萃分析显示,与细菌相比,有利于酵母生物膜抑制的显着差异。据报道,应用被动或主动和被动表面改性技术会产生更强的抑制作用。
BACKGROUND: Biofilm formation on voice prostheses is the primary reason for their premature implant dysfunction. Multiple strategies have been proposed over the last decades to achieve inhibition of biofilm formation on these devices. The purpose of this study was to assess the results of the available in vitro biofilm inhibition modalities on silicone rubber voice prostheses.
METHODS: We conducted a systematic search in PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases up to February 29, 2020. A total of 33 in vitro laboratory studies investigating the efficacy of different coating methods against Candida, Staphylococcus, Streptococcus, Lactobacilli, and Rothia biofilm growth on silicone rubber medical devices were included. Subgroup analysis linked to the type of prevention modality was carried out, and quality assessment was performed with the use of the modified CONSORT tool.
RESULTS: Data from 33 studies were included in qualitative analysis, of which 12 qualified for quantitative analysis. For yeast biofilm formation assessment, there was a statistically significant difference in favor of the intervention group (standardized mean difference [SMD] = -1.20; 95% confidence interval [CI] [-1.73, -0.66]; p < 0.0001). Subgroup analysis showed that combined methods (active and passive surface modification) are the most effective for biofilm inhibition in yeast (SMD = -2.53; 95% CI [-4.02, -1.03]; p = 0.00001). No statistically significant differences between intervention and control groups were shown for bacterial biofilm inhibition (SMD = -0.09; 95% CI [-0.68, 0.46]; p = 0.65), and the results from the subgroup analysis found no notable differences between the surface modification methods. After analyzing data on polymicrobial biofilms, a statistically significant difference in favor of prevention methods in comparison with the control group was detected (SMD = -2.59; 95% CI [-7.48, 2.31]; p = 0.30).
CONCLUSIONS: The meta-analysis on biofilm inhibition demonstrated significant differences in favor of yeast biofilm inhibition compared to bacteria. A stronger inhibition with the application of passive or combined active and passive surface modification techniques was reported.