Biofilm associated infections on medical devices: pathogenesis, diagnostic challenges, and control strategies

Biofilm-associated infections on medical devices represent a persistent and costly challenge in modern healthcare. Once established, biofilms protect microorganisms from host immunity, antibiotics, and standard disinfection procedures, leading to chronic infections, treatment failure, and frequent device removal. This review summarizes current understanding of the pathogenesis of device-associated biofilms, highlighting microbial adhesion, extracellular polymeric matrix formation, and the emergence of tolerant and persistent cell populations. We discuss diagnostic limitations, emphasizing the lack of standardized clinical tools for reliable biofilm detection, which contributes to delayed or inappropriate therapy. Current control strategies, including systemic antibiotics, antibiotic lock therapy, and combination treatments, are critically evaluated alongside emerging approaches such as antimicrobial and anti-adhesive surface coatings, metal and metal oxide nanoparticles, enzymes, phytochemicals, bacteriophages, quorum-sensing inhibitors, and probiotic-based interventions. The review also addresses regulatory, clinical, and infection-control challenges that hinder translation of promising laboratory findings into routine clinical practice. Finally, future perspectives are outlined, focusing on the need for standardized biofilm diagnostics, integration of materials science and microbiology, personalized management strategies, and context-appropriate solutions for low- and middle-income countries. Advancing multidisciplinary and translational research efforts will be essential to reduce the burden of biofilm-related medical device infections and improve patient outcomes. • Medical devices are major reservoirs for biofilm-associated infections. • Biofilms confer strong tolerance to antibiotics and disinfection. • Current diagnostics inadequately detect device-related biofilms. • Novel antibiofilm coatings and therapies show promising efficacy. • Translation to clinical use remains limited by regulatory gaps. • Multidisciplinary strategies are essential for effective control.