Bacterial Biofilms and Their Role in Chronic Infection Resistance: A Comprehensive Review

Abstract

Bacterial biofilm is a community in which the microorganisms are organized and surround themselves within self-produced matrices that are attached to surfaces, which help in protecting them against insults, and this resistance is reported to be the major cause of chronic infections and also those infections which are resistant to treatment. The presence of such a biofilm widens the gap between the results of the antibiotic tests that are performed routinely and the clinical outcomes. This conflict owned to the fact that the antibiotic resistance test performed didn't provide a complete overview about the bacterial biofilm and their resistance to antibiotics. Biofilm -related disease included several pathogenic organisms such as Pseudomonas aeruginosa, Vibrio cholerae, Staphylococcus aureus, Klebsiella pneumoniae, and Escherichia coli which are known to cause several chronic infections such as prosthetic joint infection, chronic wound colonization, and the progressive pulmonary deterioration that results from cystic fibrosis. The resistance evolved in these biofilms are owned to several mechanisms. which is emerged from the combination of physical barriers to the penetration of the drug, the presence of persisters "dormant bacterial subpopulations", the intracellular chemical signaling by quorum sensing pathway, and the powerful exchanging of genes among neighboring cells. This review examines each of these dimensions in turn, considers the clinical settings where biofilm infections impose the greatest burden, and evaluates both established and experimental treatment strategies. We also discuss why the diagnostic approaches currently available in most clinical laboratories are poorly suited to the challenge of biofilm infection, and what needs to change.