Biofilm exacerbates antibiotic resistance: Is this a current oversight in antimicrobial stewardship?

Abstract

Objective To raise awareness of the role of environmental biofilm in the emergence and spread of antibiotic resistance and its consideration in antimicrobial stewardship. Background Antibiotic resistance is a major threat to public health. Overuse of antibiotics, increased international travel, and genetic promiscuity amongst bacteria have contributed to antibiotic resistance, and global containment efforts have so far met with limited success. Antibiotic resistance is a natural mechanism by which bacteria have adapted to environmental threats over billions of years and is caused either by genetic mutations or by horizontal gene transfer. Another ancient survival strategy involves bacteria existing within a self-produced polymeric matrix, which today is termed biofilm. Biofilm similarly enables bacterial tolerance to environmental threats, and also encourages the transfer of antibiotic resistance genes between bacterial species. This natural and ubiquitous mode of bacterial life has not been considered amongst strategies to tackle antibiotic resistance in healthcare facilities, despite its ability to significantly enhance bacterial survival and persistence, and to encourage antibiotic resistance. Conclusion Biofilm must be considered synonymously with antibiotic resistance because of its proficiency in transferring resistance genes as well as its innate phenotypic tolerance to antibiotics. Although biofilm falls outside of the current definition of antimicrobial stewardship, greater awareness of the existence, ubiquity, and consequences of environmental biofilm amongst healthcare practitioners is crucial to improving hygiene practices and controlling the emergence and spread of antibiotic resistance in healthcare facilities.

Andrographis paniculata (Burm. f.) Wall. ex Nees: An Updated Review of Phytochemistry, Antimicrobial Pharmacology, and Clinical Safety and Efficacy

“…Biofilm-embedded bacteria are helped to break free from the drugs and weaken as a result [218]. Biofilm forming infections are getting severe health issues daily and significantly enhancing antibiotic resistance; some are relevant to implant-associated infections [219,220]. Exploring efficient drugs are crucial as conventional antibiotics are not sufficient to inhibit the production of biofilm.…”

Reduced metabolic activity in established Gardnerella spp. biofilms contributes to protection from the bactericidal effects of metronidazole

“…It is widely reported that biofilm formation by bacteria provides protection against antibiotics (16,18,31,32). It has also been suggested that bacterial vaginosis treatment failure and recurrence is largely because of the capacity of Gardnerella and other vaginal bacteria to form biofilm (9, 28), however, this phenomenon has not been demonstrated in vitro, and a mechanism by which biofilm formation protects Gardnerella has not been identified.…”

Bacteriophage Therapy for Difficult-to-Treat Infections: The Implementation of a Multidisciplinary Phage Task Force (The PHAGEFORCE Study Protocol)

“…In addition, some pathogens are able to form biofilms, which makes them inaccessible to the human immune system and intrinsically resistant to antibiotics [ 3 ]. Furthermore, the close proximity of bacteria in a biofilm environment facilitates the dissemination of antibiotic-resistance genes through horizontal gene transfer, thereby increasing its recalcitrance to antibiotic treatment [ 5 , 6 ]. Therefore, especially for (chronic) infections caused by (multidrug-) resistant strains, treatment options are limited.…”