Bacteria can grow either as planktonic cells or as communities within biofilms. The biofilm growth mode is the dominant lifestyle of most bacterial species and 40–80% of microorganisms are associated with biofilms [1]. Biofilm is a sessile community that is irreversibly attached to a substratum or interface or to other members of the community [2]. It is surrounded by extracellular polymeric substances (EPS) that include extracellular polysaccharides, extracellular DNA, lipids, proteins, and other elements [3]. Biofilm formation is a complex but well-regulated process that can be classified into five distinct stages [4]. In the first stage, planktonic bacteria attach to a surface. Salmonella species, Listeria monocytogenes, Campylobacter jejuni, or Escherichia coli have specific structures on the surface of the bacteria, such as flagella, curli, fimbriae, and pili, which help the bacteria attach [5].
The second stage is the adhesion step, which includes an initial reversible adhesion resulting in loose adhesion and a subsequent irreversible adhesion resulting in more stable adhesion. The third stage is to secrete EPS and form microcolonies. This is followed by biofilm maturation, which produces large amounts of EPS to grow in size and build three-dimensional structures. The final stage is the stage in which the biofilm is dispersed, releasing the planktonic cells and initiating the formation of a new biofilm at another location.
Microbial cells living within biofilms are protected from various environmental stresses such as desiccation, osmotic changes, oxidative stress, metal toxicity, radiation, antibiotics, disinfectants, and the host immune system [6]. Biofilms are much less sensitive to antimicrobial agents than planktonic cells, and several mechanisms contribute to their resistance to antimicrobials [7]. The exopolysaccharide matrix prevents the entry of antimicrobial agents by reducing diffusion and acting as a primary barrier [8]. Most antimicrobial agents kill rapidly dividing cells more effectively, but slow growth of biofilms leads to resistance [9]. Changes in metabolic activity within biofilms, genetic changes of antimicrobial resistant determinants in target cells, extrusion of antimicrobial agents using efflux pumps, and the presence of persistent cells also contribute to antimicrobial resistance [10].
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