# Biofilm Lifestyle in Recurrent Urinary Tract Infections
## 6 Strategies for Eradication of Biofilms
### Physical and Mechanical Methods for Eradication of Biofilms  
The initial steps involved in biofilm formation are highly dependent on finding a suitable niche for bacterial attachment and subsequent biofilm establishment. Naturally, the surface characteristics play a decisive role in biofilm establishment; thus, manipulation of surface characteristics represents a possible approach for inhibition of biofilm formation, with the advantage of avoiding the use of biocides for cleaning and disinfection, hence decreasing the risk of bacterial resistance development [172]. The catheter surface is one of the most favorable niches for attachment of biofilms, thus physical modifications of the surfaces of the catheters could prevent bacterial adhesion and subsequent biofilm formation. This can be achieved by modification of physical or chemical properties of biomaterials creating anti-adhesive catheters [172]. Some studies reported the application of bio-inspired techniques to provide slippery liquid-infused porous surfaces (SLIPS), which have a super-hydrophilic nature that completely inhibits bacterial attachment. Similarly, the Sharklet topography technique can be applied to modify the surface of catheters and other biomedical devices [173]. Antifouling compounds such as hydrophilic polymers, betaine-based zwitterionic polymers and amphiphilic polymers have showed considerable anti-adhesive effects. Such agents can be used for coating catheter surfaces in order to hinder bacterial colonization and build-up of biofilms.  
As for already-established biofilms, other physical interventions can be employed. An innovative photodynamic approach was tested for the ability to disintegrate mature biofilms. This approach assumes that the implementation of photosensitizing molecules to absorb the light intensity of specific wavelengths leads to targeting of bacterial cellular components [174; 175]. These photosensitizing molecules produce reactive oxygen radicals that oxidize bacterial components and eventually reflect lethal effects on the bacterial community within the biofilm [175; 176]. Electrochemical treatment is another technique that achieved promising results regarding biofilm matrix disintegration. The application of a weak electric field in the presence of antibiotics resulted in the enhanced penetration of antibiotics into the biofilm and eradication of the enclosed bacterial community using lower antibiotic concentration, in addition to biofilm destabilization and its eventual detachment as a result of the electrostatic forces generated under the direct current [177; 178]. In addition, the electric current would induce hydrolysis and ionization of the biofilm media, which has a lethal effect on microbial cells via electrophoresis and electro-osmosis [179]. The electrochemical treatment technique was successfully employed for the eradication of _Acinetobacter baumaniii_ mature biofilms that are established on porcine explant [180]. The same technique was also successfully used for the eradication of _P. aeruginosa_ biofilms formed on glass-bottomed petri dishes [181]. Nonetheless, despite these promising results, further investigations are required in order to allow for the simplification of such techniques, to facilitate their application in health care facilities in a realistic manner.