Correlation between biofilm and antibiotic resistance and possible therapeutic approaches

Antibiotic resistance is a phenomenon that occurs when bacteria no longer respond to antibiotics making these treatments ineffective; this is a pivotal problem in human health, causing 4.95 million deaths worldwide in 2019 with a predicted growth to 10 million deaths by 2050. A biofilm is a community of microorganisms held together by a self-produced extracellular matrix. Bacteria making up biofilms show an increased drug tolerance when compared to their planktonic state. The ability of biofilm to survive when high concentrations of antibiotics are present is called recalcitrance. It is crucial to examine the existing correlation between antibiotic resistance and biofilm, analysing whether the biofilm milieu inclines bacteria to the evolution of antibiotic resistance characteristics other than the one naturally occurring in the biofilm structure. This work focuses on understanding this phenomenon, to highlight some guidelines and starting points in the research for Synthetic Biology-based therapeutical strategies and approaches, driving the design of engineered biological systems capable of exerting biofilm dispersion through engineered bacteriophages by carrying out extracellular polymeric substances synthesis inhibition and degradation, as well as acting on quorum sensing interruption.