Table 3.

Competition studies in medical devices.

Antibiofilm Substances and Probiotic Strains		Abiotic Surface	Biofilm Forming Pathogens	Percentages of Reduction	Ref.	Major Conclusions
Biosurfactants	L. acidophilus L. brevis L. helveticus L. jensenii L. paracasei L. reuteri L. rhamnosus	Medical grade silicone tubes Polystyrene Polystyrene pre-coated with human plasma Silicone elastomeric discs Saliva-conditioned titanium discs	Ac. Baumannii Bac. cereus C. albicans E. coli P. aeruginosa Ser. marcescens S. aureus Strep. mutans Strep. oralis	76% 100% 90%–100% 79%–100% 100% 73% 88%–100% 99% 99%	[27] [81] [57,81] [27,81] [81] [102] [27,81] [64] [64]	Biosurfactants displayed high anti-adhesive activity and reduced biofilm biomass by 60%–100% and culturable cells by 90%–99%. The inhibitory effect was dose-dependent.
Bacteriocins	L. fermentum L. plantarum	Polystyrene	P. aeruginosa S. aureus	56%–93% 62%	[59,103] [59]	Co-incubation with bacteriocins reduced the number of P. aeruginosa culturable cells by 93% and biofilm formation of pathogens by 56%–62%.
EPS	L. delbrueckii ssp. bulgaricus L. fermentum L. rhamnosus	Polystyrene	Bac. cereus Ent. faecalis Lis. monocytogenes P. aeruginosa	90% 87% 88% 88%–97%	[108] [108] [108] [103,108]	Co-incubation with EPS reduced the number of P. aeruginosa culturable cells by 97% and inhibited biofilm formation between 74% and 90%, depending on the species, in a dose-dependent manner.
Cell-free supernatants	Bac. subtilis L. acidophilus L. fermentum L. gasseri L. helveticus L. paracasei L. plantarum L. rhamnosus Strep. salivarius	Glass Polystyrene Polyurethane PVC Saliva-conditioned titanium discs Silicone	C. albicans C. krusei C. parapsilosis C. tropicalis Ent. faecalis E. coli K. pneumoniae P. aeruginosa S. aureus Strep. mutans Strep. oralis	90% 71% 41% 67% 61% 63% 99% 57% 57%–99% 53%–99% 99%	[87] [88] [88] [88] [109] [109] [110] [91] [91,111] [96,98,112] [96]	CFS were able to reduce the number of biofilm cells by more than 81% and inhibit the ability of pathogens to adhere to the different surfaces by 39–99%. Neutralized supernatants had less effect on biofilm formation.
Cells	E. coli Nissle 1917 L. acidophilus L. casei L. casei rhamnosus L. fermentum L. helveticus L. paracasei L. plantarum L. rhamnosus L. rhamnosus GG L. salivarius Lact. lactis ssp. lactis Strep. thermophilus	Bovine enamel saliva-coated Glass Polystyrene Polyurethane Polypropylene Saliva-coated hydroxyapatite discs Saliva-conditioned titanium discs Silicone latex Silicone rubber	A. naeslundii C. albicans E. coli F. nucleatum K. pneumoniae Non-mutans streptococci strains P. aeruginosa S. aureus S. epidermidis Strep. mutans Strep. oralis Strep. sanguinisStrep. sobrinus V. díspar	22% 53%–72% 82%–93% 55% 99% 11% N.A. 99% 99% 9%–99% 65%–99% N.A. 76% 32%	[104] [63,87] [93,113,114] [104] [110] [106] [113] [94,113] [113] [63,95,96,106,112] [96,104] [63] [104] [104]	The adhesion of pathogens was reduced by the presence of probiotic cells (11%–93%), and their culturability decreased up to 7.2 Log CFU. L. rhamnosus microcapsules reduced biofilm formation up to 82% in a dose-dependent manner. Lactobacillus strains inhibited the growth of an uropathogenic biofilm on silicone rubber for at least 8 days. EcN was able to outcompete pathogenic strains during biofilm formation, reducing culturability up to 4 Log.
Lipoteichoic acid (LTA)	L. plantarum	Glass Human dentin slices Polystyrene Saliva-coated hydroxyapatite discs	A. naeslundii Ent. faecalis L. salivarius Strep. mutans	57% 57% 57% 57%–75%	[97] [97] [97] [97,98]	LTA inhibited single- and multi-species biofilm formation by 75% and 57%, respectively.

Abbreviations: CFS, Cell-Free Supernatant; CFU, Colony-Forming Units; EcN, E. coli Nissle 1917; EPS, Exopolysaccharides; PVC, Polyvinyl Chloride; N.A., Not Available. Ac., Acinetobacter; A., Actinomyces; Bac., Bacillus; C., Candida; Ent., Enterococcus; E., Escherichia; F., Fusobacterium; K., Klebsiella; L., Lactobacillus; Lact., Lactococcus; Lis., Listeria; P., Pseudomonas; Ser., Serratia; S., Staphylococcus; Strep., Streptococcus; V., Veillonella.