Silent Architects of Chronic Disease: Biofilm Biology, Clinical Impact, and Therapeutic Innovations (Biofilms in Chronic Infections)

Abstract

Biofilms are structured microbial communities embedded in extracellular polymeric substances (EPS), playing a pivotal role in chronic infections and antimicrobial resistance.This paper’s objective is to systematically synthesize current evidence on biofilm formation, clinical implications, resistance mechanisms and emerging therapeutic strategies. A PRISMA-informed narrative review was conducted using PubMed, Scopus and Web of Science (2000–2025). Studies on biofilm-associated infections, molecular mechanisms and treatment strategies were included. The results elucidated that Biofilms demonstrate complex architecture, quorum sensing–mediated regulation and high resistance via diffusion barriers, persister cells and genetic adaptation. Clinical conditions such as chronic wounds, respiratory infections and implant-associated infections are strongly linked to biofilms. Chronic infections represent a significant burden on global healthcare systems, often demonstrating resistance to conventional antimicrobial therapy. A key contributor to this persistence is the formation of microbial biofilms—complex, structured communities of microorganisms embedded within an extracellular polymeric matrix. This paper explores the molecular mechanisms of biofilm formation, their role in chronic infections and emerging therapeutic strategies. Emerging therapies including nanotechnology, quorum sensing inhibitors and bacteriophage therapy show promising outcomes critical for advancing treatment protocols and improving patient outcomes.