Tackling Biofilm-Forming Pathogens: A Challenge to Overcome in the Fight Against Infectious Diseases

Microorganisms can aggregate and organise into structured communities embedded within an exopolysaccharide-based matrsix, which serves as a protective barrier and a functional environment around microbial cells. The formation of biofilms is widely recognised as a pivotal factor in bacterial virulence, impeding the efficacy of antimicrobial agents and hindering immune responses, whilst concomitantly contributing to the development of antimicrobial resistance and the onset of persistent infections. Biofilm formation is a tightly regulated and dynamic process, controlled by quorum-sensing mechanisms and profoundly influenced by environmental factors and nutrient availability. The objective of this review is to elucidate the significance of biofilms in clinical settings, with a particular focus on their role in the pathogenesis of infectious diseases. Particular attention is devoted to biofilm-associated infections and infections related to invasive medical devices, with a particular emphasis on the most prevalent microbial pathogens, which include S. aureus, S. epidermidis, P. aeruginosa, E. coli, K. pneumoniae, A. baumannii and various species of Candida. Furthermore, the present review encompasses biofilm-associated chronic infections, conditions manifesting in predisposed patients, including individuals affected by cystic fibrosis. This review further examines the most recent strategies for combating antibiotic resistance in bacterial biofilms. This review focuses on recent biofilm pathogenesis advancements, with a focus on diagnosis challenges and the need for new ways to disrupt biofilm integrity.