## 7 Approaches to Prevent and Manage Infections Caused by Biofilms
### Therapeutic Strategies
#### 7.1.1 DNase as a Biofilm-Disrupting Agent  
Deoxyribonuclease (DNase) enzymatically degrades eDNA, a key structural component of the biofilm matrix. By breaking down eDNA, DNase disrupts the integrity of the  
\begin{table}
\begin{tabular}{c c c c} \hline \hline
**Aspect** & **Description** & **Examples** & **Citation** \\ \hline Chronic Wounds & Chronic biofilm infections hinder the process of healing. Biofilms provide protection for bacteria against therapies and immunological reactions. Result in extended inflammation and hinder the healing of wounds. & Conditions such as diabetic foot ulcers, venous leg ulcers, pressure ulcers, and surgical wound infections. & [209, 210, 211, 201, 212] \\ \hline \multirow{4}{*}{Medical Device Infections} & Biofilms develop on medical equipment such as catheters and prostheses. Device-related infections can be induced, and their treatment can be challenging without the removal of the device. Possibility of dissemination of infection throughout the body. & Cattherers, sutures, orthopedic implants, heart valves, and vascular grafts & [15,192] \\ \hline \multirow{4}{*}{Antibiotic Resistance} & Biofilms enhance the transmission of genes that confer resistance. Offer resistance against antibiotics. The administration of elevated antibiotic doses is necessary for treatment, hence facilitating the emergence of antibiotic resistance. & _MRSA_ present in biofilms, _P. aeruginosa_ is commonly seen in lung infections associated with cystic fibrosis. & [114,115] \\ \hline \multirow{4}{*}{Dental Health} & Dental plaque is a prevalent accumulation of microorganisms in the mouth. Results in dental caries, inflammation of the gums, and advanced gum disease. Controlled with consistent oral hygiene habits. & The conditions mentioned are dental caries (tooth decay), gingivitis, periodontitis, and dental implant-related mucositis. & [240,241] \\ \cline{2-5}  & Hospitals pose a significant risk for infections caused by biofilms. Infection transmission is facilitated by the presence of biofilms on medical equipment, water systems, and hands. Challenge for individuals with immunodeficiency or intrusive medical devices. & Central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia & [242, 243, 244, 245] \\ \cline{1-1} \cline{2-5}  & & (VAP), SSIs, and hospital-acquired urinary tract infections. & \\ \hline \hline \end{tabular}
\end{table}
Table 2: An examination of the health complications associated with biofilms, ranging from persistent wounds to infections acquired in hospitals.  
biofilm, weakening its structure and making it more susceptible to external interventions. This degradation enhances the penetration of antibiotics into the biofilm, thereby increasing their efficacy and improving treatment outcomes for persistent infections [246; 247].  
DNase effectively treats biofilms in both in vitro and in vivo models. Studies indicate that DNase diminishes biofilm biomass and enhances the susceptibility of bacteria within biofilms to antibiotics [248]. In patients with cystic fibrosis, DNase therapy, specifically recombinant human DNase (rhDNase), is employed to degrade the DNA-rich mucus in the lungs [249]. This treatment indirectly interferes with biofilm-like aggregates, resulting in enhanced respiratory function. The capacity of DNase to improve antibiotic efficacy highlights its potential as a significant adjunct in therapies aimed at biofilms [250; 251].