Strategies to overcome biofilm resistance

Biofilm have been found to be involved in a wide variety of microbial infections in the body, by one estimate 80% of all infections. A number of anti-biofilm strategies have emerged to prevent the colonization and formation of biofilms. However, there are four main intervention strategies in clinical practice for biofilm-associated infections. The first strategy is to prevent the initial microbial cell attachment through the material surface modification of the medical devices. Second, for an established infection, removal of the infected device is the definitive treatment strategy that is common usually; nevertheless this can cause adverse collateral effects in the patient. Third, agents such as liposomes, polymer-based and nanoparticles are used to penetrate and enhance the antimicrobial transport into the biofilm matrix in order to kill the embedded organisms. Lastly, therapies that can prevent more than one biofilms mechanism simultaneously, as antimicrobial photodynamic therapy (aPDT) that being a multi-target process, there is no development of microbial resistance. So, this review will focus on the mechanisms of biofilm resistance and the therapeutic strategies to overcome that.