Biofilms and Antimicrobial Resistance: Mechanisms, Clinical Implications, and Emerging Interventions
Kamal A. Qureshi, Nada A. Fahmy, Adil Parvez, Hanan Almahasheer, Devi Permatasari, Mariusz Jaremko, Emad M. Abdallah
Abstract
Biofilms are structured microbial communities that contribute significantly to the persistence and spread of antimicrobial resistance (AMR), posing major clinical and environmental challenges. This review consolidates current insights into the molecular mechanisms underpinning biofilm-associated antibiotic resistance-focusing on extracellular polymeric substances (EPS), phenotypic tolerance, and horizontal gene transfer-and explores how these factors create resilient microbial ecosystems. We further discuss environmental reservoirs such as wastewater, soil, and food-processing systems as hidden sources of resistant pathogens within the One Health framework. Diagnostic and therapeutic limitations are evaluated, highlighting how biofilm heterogeneity complicates detection and treatment. Finally, we examine emerging antibiofilm strategies, including small molecules, enzymes, bacteriophages, nanoparticles, and antimicrobial peptides, along with surveillance and preventive approaches for healthcare and industrial settings. This comprehensive synthesis underscores the need for interdisciplinary research and innovative interventions to mitigate the global burden of biofilm-mediated antimicrobial resistance.