Biofilms Formation and Their Significance in Some Human Infections
DOI:
https://doi.org/10.11603/1681-2727.2026.2.16502Keywords:
biofilms, osteomyelitis, urinary tract infections, COPD, cystic fibrosisAbstract
SUMMARY. Biofilms are complex, structured microbial communities that form on biological tissues and surfaces of medical devices, playing a crusial role in the development of chronic infections. Biofilm formation is mediated by an extracellular polymeric matrix (EPM), consisting of polysaccharides, proteins, and extracellular DNA (e-DNA). This matrix protects microorganisms from the host’s immune response and significantly increases their resistance to antimicrobial drugs. Pathogens such as Staphylococcus aureus, including methicillin-resistant strains (MRSA), Escherichia coli, Pseudomonas aeruginosa, and Haemophilus influenzae are most frequently implicated in biofilm formation.
Biofilms play an important role in the pathogenesis of many chronic and recurrent infections, including osteomyelitis, infective endocarditis, urinary tract infections (UTIs), and catheter-associated infections. They are of particular clinical significance in respiratory diseases – spesifically chronic obstructive pulmonary disease (COPD), cystic fibrosis, and bronchiectasis. In these conditions, biofilm formation facilitates to the pathogen persistence, drives chronic inflammation, and markedly diminishes the efficacy of antibacterial therapy.
Moreover, biofilms can develp on the surfaces of diverse medical devices, such as urinary catheters, prosthetic heart valves, and other invasive implants. The formation of biofilms on these surfaces provides a protected niche that facilitate microbial colonization, proliferation, and the subsequent systemic spread of infections. Consequently, managing these infections becomes significantly more complex, as the risk of recurrence rises and the necessity for prolonged or combination antibacterial therapy increases.
References
Schulze, A., Mitterer, F., Pombo, J. P., & Schild, S. (2021). Biofilms by bacterial human pathogens: Clinical relevance – development, composition and regulation – therapeutical strategies. Microbial cell (Graz, Austria), 8(2), 28–56. https://doi.org/10.15698/mic2021.02.741 DOI: https://doi.org/10.15698/mic2021.02.741
Zhao, A., Sun, J., & Liu, Y. (2023). Understanding bacterial biofilms: From definition to treatment strategies. Frontiers in cellular and infection microbiology, 13, 1137947. https://doi.org/10.3389/fcimb.2023.1137947 DOI: https://doi.org/10.3389/fcimb.2023.1137947
Wang, X., Liu, M., Yu, C. et al. (2023). Biofilm formation: mechanistic insights and therapeutic targets. Mol Biomed 4, 49. https://doi.org/10.1186/s43556-023-00164-w DOI: https://doi.org/10.1186/s43556-023-00164-w
Lu, L., Zhao, Y., Li, M., Wang, X., Zhu, J., Liao, L., & Wang, J. (2024). Contemporary strategies and approaches for characterizing composition and enhancing biofilm penetration targeting bacterial extracellular polymeric substances. Journal of pharmaceutical analysis, 14(4), 100906. https://doi.org/10.1016/j.jpha.2023.11.013 DOI: https://doi.org/10.1016/j.jpha.2023.11.013
Leo JC. (2025). Interaction between bacterial adhesins leads to coaggregation by the oral bacteria Veillonella parvula and Streptococcus gordonii. mBio, 16:e03279-24. doi.org/10.1128/mbio.03279-24 DOI: https://doi.org/10.1128/mbio.03279-24
6. Dorison, L., Béchon, N., Martin-Gallausiaux, C., Chamorro-Rodriguez, S., Vitrenko, Y., Ouazahrou, R., Villa, R., Deschamps, J., Briandet, R., Gribaldo, S., Ghigo, J.M., & Beloin, C. (2024). Identification of Veillonella parvula and Streptococcus gordonii adhesins mediating co-aggregation and its impact on physiology and mixed biofilm structure. mBio, 15.doi: 10.1128/mbio.02171-24 DOI: https://doi.org/10.1128/mbio.02171-24
Liu, Y., Long, S., Wang, H., & Wang, Y. (2024). Biofilm therapy for chronic wounds. International wound journal, 21(2), e14667. https://doi.org/10.1111/iwj.14667. DOI: https://doi.org/10.1111/iwj.14667
Wu S, Wu B, Liu Y, Deng S, Lei L and Zhang H (2022) Mini Review Therapeutic Strategies Targeting for Biofilm and Bone Infections. Front. Microbiol. 13:936285. doi: 10.3389/fmicb.2022.936285 DOI: https://doi.org/10.3389/fmicb.2022.936285
De Angelis, A., Marchello, M., Tramontano, A., Cicchetti, M., Nigro, M., Simonetta, E., Scarano, P., Polelli, V., Artuso, V. A., & Aliberti, S. (2025). Haemophilus influenzae in bronchiectasis. European respiratory review : an official journal of the European Respiratory Society, 34(177), 250007. https://doi.org/10.1183/16000617.0007-2025 DOI: https://doi.org/10.1183/16000617.0007-2025
Shen, A. Z., Taha, M., Ghannoum, M., & Tyring, S. K. (2025). Biofilms and Chronic Wounds: Pathogenesis and Treatment Options. Journal of Clinical Medicine, 14(21), 7784. https://doi.org/10.3390/jcm14217784 DOI: https://doi.org/10.3390/jcm14217784
Ghaithi, Ahmed Al; Husband, John; Kindi, Attika Al; Mohammed Al; Maskari, Sultan Al (2025) «Biofilm-Induced Bone Degradation in Osteomyelitis: Insights from a comprehensive ex vivo pathogen interaction study,» Sultan Qaboos University Medical Journal: Vol. 25:98-104. https://doi.org/10.18295/squmj.10.2024.053 DOI: https://doi.org/10.18295/squmj.10.2024.053
de Mesy Bentley, K. L., Galloway, C. A., Muthukrishnan, G., Echternacht, S. R., Masters, E. A., Zeiter, S., Schwarz, E. M., & Leckenby, J. I. (2021). Emerging electron microscopy and 3D methodologies to interrogate Staphylococcus aureus osteomyelitis in murine models. Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 39(2), 376–388. https://doi.org/10.1002/jor.24968 DOI: https://doi.org/10.1002/jor.24968
Perry EK, Tan MW. (2023) Bacterial biofilms in the human body: prevalence and impacts on health and disease. Front Cell Infect Microbiol. 13:1237164. doi: 10.3389/fcimb.2023.1237164. DOI: https://doi.org/10.3389/fcimb.2023.1237164
Metaoy, S., Rusu, I., & Pillai, A. (2024). Adjuvant local antibiotic therapy in the management of diabetic foot osteomyelitis. Clinical diabetes and endocrinology, 10(1), 51. https://doi.org/10.1186/s40842-024-00200-w DOI: https://doi.org/10.1186/s40842-024-00200-w
Rubitschung, K., Sherwood, A., Crisologo, A. P., Bhavan, K., Haley, R. W., Wukich, D. K., Castellino, L., Hwang, H., La Fontaine, J., Chhabra, A., Lavery, L., & Öz, O. K. (2021). Pathophysiology and Molecular Imaging of Diabetic Foot Infections. International Journal of Molecular Sciences, 22(21), 11552. https://doi.org/10.3390/ijms222111552 DOI: https://doi.org/10.3390/ijms222111552
Macdonald, K. E., Boeckh, S., Stacey, H. J., & Jones, J. D. (2021). The microbiology of diabetic foot infections: a meta-analysis. BMC infectious diseases, 21(1), 770. https://doi.org/10.1186/s12879-021-06516-7 DOI: https://doi.org/10.1186/s12879-021-06516-7
Mudrik-Zohar H, Carasso S, Gefen T, Zalmanovich A, Katzir M, Cohen Y, Paitan Y, Geva-Zatorsky N, Chowers M. (2022). Microbiome Characterization of Infected Diabetic Foot Ulcers in Association With Clinical Outcomes: Traditional Cultures Versus Molecular Sequencing Methods. Front Cell Infect Microbiol. 12:836699. doi:10.3389/fcimb.2022.836699. DOI: https://doi.org/10.3389/fcimb.2022.836699
Villa F, Marchandin H, Lavigne J-P, Schuldiner S, Cellier N, Sotto A, Loubet P. (2024) Anaerobes in diabetic foot infections: pathophysiology, epidemiology, virulence, and management. Clin Microbiol Rev. 37(3):e0014323. doi:10.1128/cmr.00143-23. DOI: https://doi.org/10.1128/cmr.00143-23
Aydingoz U. (2023). Imaging Osteomyelitis: An Update. Bildgebung der Osteomyelitis: ein Update. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, 195(4), 297–308. https://doi.org/10.1055/a-1949-7641 DOI: https://doi.org/10.1055/a-1949-7641
Armstrong, D. G., Tan, T. W., Boulton, A. J. M., & Bus, S. A. (2023). Diabetic Foot Ulcers: A Review. JAMA, 330(1), 62–75. https://doi.org/10.1001/jama.2023.10578 DOI: https://doi.org/10.1001/jama.2023.10578
López-Carriches, C., Mateos-Moreno, M. V., Taheri, R., López-Quiles Martínez, J., & Madrigal-Martínez-Pereda, C. (2025). Chronic Osteomyelitis of the Jaw. Osteomyelitis. Journal of clinical and experimental dentistry, 17(3), e324–e328. https://doi.org/10.4317/jced.62596 DOI: https://doi.org/10.4317/jced.62596
Lauten, A., Martinović, M., Kursawe, L., Kikhney, J., Affeld, K., Kertzscher, U., Falk, V., & Moter, A. (2021). Bacterial biofilms in infective endocarditis: an in vitro model to investigate emerging technologies of antimicrobial cardiovascular device coatings. Clinical research in cardiology : official journal of the German Cardiac Society, 110(3), 323–331. https://doi.org/10.1007/s00392-020-01669-y DOI: https://doi.org/10.1007/s00392-020-01669-y
Nappi F, Martuscelli G, Bellomo F, Avtaar Singh SS, Moon MR. (2022) Infective Endocarditis in High-Income Countries. Metabolites. 12(8):682. doi:10.3390/metabo12080682. DOI: https://doi.org/10.3390/metabo12080682
Vestby LK, Grønseth T, Simm R, Nesse LL. (2020) Bacterial Biofilm and its Role in the Pathogenesis of Disease. Antibiotics (Basel). 9(2):59. doi:10.3390/antibiotics9020059. DOI: https://doi.org/10.3390/antibiotics9020059
Ekwueme DE, Sann K, Rahman MM. Coexistence of Maturity-Onset (2025) Diabetes of the Young Type 3 (MODY 3) and Diabetic Ketoacidosis: A Report of a Rare Case. Cureus. 17(11):e96360. doi: 10.7759/cureus.96360. DOI: https://doi.org/10.7759/cureus.96360
Kaushik A, Kest H, Sood M, Thieman C, Steussy BW, Padomek M, Gupta S. (2024) Infective Endocarditis by Biofilm-Producing MethicillinResistant Staphylococcus aureus-Pathogenesis, Diagnosis, and Management. Antibiotics (Basel). 13(12):1132. doi:10.3390/antibiotics13121132. DOI: https://doi.org/10.3390/antibiotics13121132
Patel H, Rawat S. (2023) A genetic regulatory see-saw of biofilm and virulence in MRSA pathogenesis. Front Microbiol. 14:1204428. doi:10.3389/fmicb.2023.1204428. DOI: https://doi.org/10.3389/fmicb.2023.1204428
Silva V, Almeida L, Gaio V, Cerca N, Manageiro V, Caniça M, Capelo JL, Igrejas G, Poeta P. (2021) Biofilm Formation of Multidrug-Resistant MRSA Strains Isolated from Different Types of Human Infections. Pathogens. 10(8):970. doi:10.3390/pathogens10080970. DOI: https://doi.org/10.3390/pathogens10080970
Widmer D, Widmer AF, Jeger R, Dangel M, Stortecky S, Frei R, Conen A. (2022) Prevalence of enterococcal groin colonization in patients undergoing cardiac interventions: challenging antimicrobial prophylaxis with cephalosporins in patients undergoing transcatheter aortic valve replacement. J Hosp Infect. 198202. doi:10.1016/j.jhin.2022.07.020. DOI: https://doi.org/10.1016/j.jhin.2022.07.020
Khan A, Aslam A, Satti KN, Ashiq S. (2020) Infective endocarditis posttranscatheter aortic valve implantation (TAVI), microbiological profile and clinical outcomes: A systematic review. PLoS One. 15(1):e0225077. doi:10.1371/journal.pone.0225077. DOI: https://doi.org/10.1371/journal.pone.0225077
Del Val D, Panagides V, Mestres CA, Miró JM, Rodés-Cabau J. (2023) Infective Endocarditis After Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review. J Am Coll Cardiol. 81(4):394-412. doi:10.1016/j.jacc.2022.11.028. DOI: https://doi.org/10.1016/j.jacc.2022.11.028
Zhou Y, Zhou Z, Zheng L, Gong Z, Li Y, Jin Y, Huang Y, Chi M. (2023) Urinary Tract Infections Caused by Uropathogenic Escherichia coli: Mechanisms of Infection and Treatment Options. Int J Mol Sci. 24(13):10537. doi: 10.3390/ijms241310537. DOI: https://doi.org/10.3390/ijms241310537
Lila ASA, Rajab AAH, Abdallah MH, Rizvi SMD, Moin A, Khafagy ES, Tabrez S, Hegazy WAH. (2023) Biofilm Lifestyle in Recurrent Urinary Tract Infections. Life (Basel). 13(1):148. doi:10.3390/life13010148. DOI: https://doi.org/10.3390/life13010148
Rubi H, Mudey G, Kunjalwar R. (2022) Catheter-Associated Urinary Tract Infection (CAUTI). Cureus. 14(10):e30385. doi:10.7759/cureus.30385. DOI: https://doi.org/10.7759/cureus.30385
Werneburg G. T. (2022). Catheter-Associated Urinary Tract Infections: Current Challenges and Future Prospects. Research and reports in urology, 14, 109–133. https://doi.org/10.2147/RRU.S273663 DOI: https://doi.org/10.2147/RRU.S273663
He W., Ma P., Li L., Wang D., Li X., Wen X., Zuo Y., Guo Q., Zhang Y., Cheng R., Wang Z. (2024). Efficacy and safety of preventing catheter-associated urinary tract infection by inhibiting catheter bacterial biofilm formation: a multicenter randomized controlled trial. Antimicrob Resist Infect Control. 13(1):96. doi:10.1186/s1375602401450-0. DOI: https://doi.org/10.1186/s13756-024-01450-0
Nye T. M., Zou Z., Obernuefemann C. L. P., Pinkner J. S., Lowry E., Kleinschmidt K., Bergeron K., Klim A., Dodson K. W., Flores-Mireles A. L., Walker J. N., Wong D. G., Desai A., Caparon M. G., Hultgren S. J. (2024). Microbial co-occurrences on catheters from long-term catheterized patients. Nat Commun. 15(1):61. doi:10.1038/s4146702344095-0. DOI: https://doi.org/10.1038/s41467-023-44095-0
Medina-Polo J, Naber KG, Bjerklund Johansen TE. (2021) Healthcareassociated urinary tract infections in urology. GMS Infect Dis. 9:D oc05. doi:10.3205/id000074. DOI: https://doi.org/10.5680/LHUII000066
Tegegne DT, Abbott IJ, Poźniak B. (2025) Catheter-Associated Urinary Tract Infections: Understanding the Interplay Between Bacterial Biofilm and Antimicrobial Resistance. Int J Mol Sci. 26(18):9193. doi:10.3390/ijms26189193. DOI: https://doi.org/10.3390/ijms26189193
Riquelme SA, Wong Fok Lung T, Prince A. (2020) Pulmonary Pathogens Adapt to Immune Signaling Metabolites in the Airway. Front Immunol. 11:385. doi:10.3389/fimmu.2020.00385. DOI: https://doi.org/10.3389/fimmu.2020.00385
Riquelme SA, Prince A. (2020) Airway immunometabolites fuel Pseudomonas aeruginosa infection. Respir Res. 21(1):326. doi:10.1186/s1293102001591-x. DOI: https://doi.org/10.1186/s12931-020-01591-x
Hall-Stoodley L, McCoy KS. (2022) Biofilm aggregates and the host airwaymicrobial interface. Front Cell Infect Microbiol. 12:969326. doi:10.3389/fcimb.2022.969326.
Magalhães AP, França A, Pereira MO, Cerca N. (2022) Unveiling CoInfection in Cystic Fibrosis Airways: Transcriptomic Analysis of Pseudomonas aeruginosa and Staphylococcus aureus Dual-Species Biofilms. Front Genet., 13:883199. doi:10.3389/fgene.2022.883199. DOI: https://doi.org/10.3389/fgene.2022.883199
Stankovic MM. (2025) Lung Microbiota: From Healthy Lungs to Development of Chronic Obstructive Pulmonary Disease. Int J Mol Sci. 26(4):1403. doi:10.3390/ijms26041403. DOI: https://doi.org/10.3390/ijms26041403
Weeks JR, Staples KJ, Spalluto CM, Watson A, Wilkinson TMA. (2021) The Role of Non-Typeable Haemophilus influenzae Biofilms in Chronic Obstructive Pulmonary Disease. Front Cell Infect Microbiol. 11:720742. doi:10.3389/fcimb.2021.720742. DOI: https://doi.org/10.3389/fcimb.2021.720742
Short B, Carson S, Devlin AC, Reihill JA, Crilly A, MacKay W, Ramage G, Williams C, Lundy FT, McGarvey LP, Thornbury KD, Martin SL. (2021) Non-typeable Haemophilus influenzae chronic colonization in chronic obstructive pulmonary disease (COPD). Crit Rev Мicrobiol. 47(2):192-205. doi:10.1080/1040841X.2020.1863330. DOI: https://doi.org/10.1080/1040841X.2020.1863330
Kolpen M, Kragh KN, Enciso JB, Faurholt-Jepsen D, Lindegaard B, Egelund GB, Jensen AV, Ravn P, Mathiesen IHM, Gheorge AG, Hertz FB, Qvist T, Whiteley M, Jensen PØ, Bjarnsholt T. (2022) Bacterial biofilms predominate in both acute and chronic human lung infections. Thorax. 77(10):1015-1022. doi:10.1136/thoraxjnl2021-217576. DOI: https://doi.org/10.1136/thoraxjnl-2021-217576
Reece E, Bettio PHA, Renwick J. (2021) Polymicrobial Interactions in the Cystic Fibrosis Airway Microbiome Impact the Antimicrobial Susceptibility of Pseudomonas aeruginosa. Antibiotics (Basel). 10(7):827. doi:10.3390/antibiotics10070827. DOI: https://doi.org/10.3390/antibiotics10070827
Jurado-Martín I, Sainz-Mejías M, McClean S. (2021) Pseudomonas aeruginosa: An Audacious Pathogen with an Adaptable Arsenal of Virulence Factors. Int J Mol Sci. 22(6):3128. doi:10.3390/ijms22063128. DOI: https://doi.org/10.3390/ijms22063128
Hall-Stoodley L, McCoy KS. (2022) Biofilm aggregates and the host airwaymicrobial interface. Front Cell Infect Microbiol. 12:969326. doi:10.3389/fcimb.2022.969326. DOI: https://doi.org/10.3389/fcimb.2022.969326
Marsh RL, Binks MJ, Smith-Vaughan HC, Janka M, Clark S, Richmond P, Chang AB, Thornton RB. (2022) Prevalence and subtyping of biofilms present in bronchoalveolar lavage from children with protracted bacterial bronchitis or non-cystic fibrosis bronchiectasis: a cross-sectional study. Lancet Microbe. e215e223. doi:10.1016/S26665247(21)00300-1. DOI: https://doi.org/10.1016/S2666-5247(21)00300-1
Chalmers JD, Polverino E, Crichton ML, Ringshausen FC, De Soyza A, Vendrell M, Burgel PR, Haworth CS, Loebinger MR, Dimakou K, Murris M, Wilson R, Hill AT, Menendez R, Torres A, Welte T, Blasi F, Altenburg J, Shteinberg M, Boersma W, Elborn JS, Goeminne PC, Aliberti S. EMBARC Registry Investigators. (2023) Bronchiectasis in Europe: data on disease characteristics from the European Bronchiectasis registry (EMBARC). Lancet Respir Med. 11(7):637-649. doi:10.1016/S2213-2600(23)00093-0. DOI: https://doi.org/10.1016/S2213-2600(23)00093-0
Yang SH, Song MJ, Kim YW, Kwon BS, Lim SY, Lee YJ, Park JS, Cho YJ, Lee JH, Lee CT, Kim HJ. (2024) Understanding the effects of Haemophilus influenzae colonization on bronchiectasis: a retrospective cohort study. BMC Pulm Med. doi:10.1186/s12890024-02881-6. DOI: https://doi.org/10.1186/s12890-023-02823-8
Nigro M, Laska IF, Traversi L, Simonetta E, Polverino E. (2024) Epidemiology of bronchiectasis. Eur Respir Rev. 33(174):240091. doi:10.1183/16000617.0091-2024. DOI: https://doi.org/10.1183/16000617.0091-2024
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