Combating Pseudomonas aeruginosa biofilms: Pathogenesis, resistance mechanisms and novel treatment approaches in an era of emerging antimicrobial resistance

Biofilms are complex associations of microorganisms that are adhere to both biotic surfaces (e.g., living tissues) and abiotic surfaces (e.g., medical implants). These microorganisms, embedded in their own self-produced extracellular polymeric substance matrix, can be protected from unfavorable conditions. Among biofilm forming pathogens, Pseudomonas aeruginosa is an opportunistic bacteria associated with persistent and chronic infections due to its strong biofilm forming ability and high resistance to antibiotics. This paper focuses on P. aeruginosa biofilms, including the steps of biofilm development, their structural organization and genetic regulation, and the environmental factors affecting their survival. Biofilms exhibit significant resistance to conventional treatments, contributing to the persistence of chronic infections, implant-related infections, and non-healing wounds. The article discusses the diagnostic challenges and limitations of current antimicrobial treatment for P. aeruginosa biofilm associated infections. Recent approaches to improving clinical outcomes are also discussed, including the use of new antibiofilm compounds, mechanical solutions, and alternatives such as phage therapy, which integrate current knowledge of P. aeruginosa biofilm-related diseases to optimize therapeutic strategies for addressing antimicrobial resistance and improve patient outcomes.