Biofilm Dynamics in Chronic Infection Management

Biofilms are structured communities of microorganisms encased in a self-produced matrix that adhere to host tissues or medical devices and are implicated in persistent infections. Their development proceeds through attachment, microcolony formation, maturation and dispersion, yielding spatial heterogeneity in metabolic activity and oxygen availability that underlies antibiotic tolerance and immune evasion. In chronic wounds, cystic fibrosis airways and implanted devices, biofilms resist clearance by forming microenvironments in which cells adopt a slow-growing or dormant state and exchange signals via quorum sensing to regulate virulence and matrix production. The extracellular polymeric substance (EPS) not only confers structural stability but also acts as a diffusion barrier to antimicrobial agents and host defences. Management strategies encompass mechanical disruption, targeted delivery of antimicrobials, use of dispersal molecules and modulation of host immunity. Recent innovations have centred on exploiting alternative chemistries to neutralise virulence factors, sensing technologies for early detection and multi-targeted therapies that disrupt EPS architecture, inhibit communication pathways and resensitise cells to conventional antibiotics. Effective chronic infection management requires an integrated approach that combines diagnostics, physical interventions and precisely tailored antibiofilm agents to overcome the recalcitrance of microbial communities and promote tissue healing.

Research from Nature Portfolio

A novel approach based on host-guest chemistry has yielded a water-soluble synthetic macrocycle capable of binding key Gram-negative virulence factors without directly killing bacteria. By sequestering homoserine lactones and lipopolysaccharides, this macrocycle suppresses toxin production and disrupts biofilm integrity in multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. When combined with standard antibiotics, enhanced penetration into the biofilm matrix restores antimicrobial efficacy. In vivo models demonstrate reduced colonisation and immune activation, highlighting the potential of non-bactericidal antivirulence strategies to evade resistance mechanisms and potentiate existing therapies against chronic infections.

Biofilm Dynamics in Chronic Infection Management publication trend

The graph below shows the total number of articles in biofilm dynamics in chronic infection management across all publications each year (not limited to Nature Index journals).

Technical terms

Biofilm: A multicellular community of microbes embedded in a self-produced extracellular matrix that adheres to surfaces or tissues and exhibits enhanced resistance to antimicrobials and host defences.

Extracellular Polymer ic Substance (EPS): The self-assembled mesh of polysaccharides, proteins, nucleic acids and lipids that provides structural integrity and protective barrier functions within a biofilm.

Quorum Sensing: A cell-to-cell communication mechanism whereby bacteria release and detect small signalling molecules to coordinate gene expression and collective behaviours in response to population density.

Debridement: The mechanical or surgical removal of necrotic tissue and biofilm from a wound bed to reduce microbial burden and enhance the efficacy of topical treatments.

Planktonic Phenotype: The free-living, single-cell state of microorganisms, in contrast to the aggregated or Matrix-embedded biofilm state, often more susceptible to antimicrobial agents.

References

1. Repurposing host-guest chemistry to sequester virulence and eradicate biofilms in multidrug resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Nature Communications (2023).
2. Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds. Wound Repair and Regeneration (2017).
3. What's on the Outside Matters: The Role of the Extracellular Polymeric Substance of Gram-negative Biofilms in Evading Host Immunity and as a Target for Therapeutic Intervention*. Journal of Biological Chemistry (2016).
4. Advances in the Sensing and Treatment of Wound Biofilms. Angewandte Chemie International Edition (2022).
5. Reaction–diffusion theory explains hypoxia and heterogeneous growth within microbial biofilms associated with chronic infections. npj Biofilms and Microbiomes (2016).
6. Targeting Biofilms Therapy: Current Research Strategies and Development Hurdles. Microorganisms (2020).