Innate and induced resistance mechanisms of bacterial biofilms.

Bacterial biofilms are highly recalcitrant to antibiotic treatment, which holds serious consequences for therapy of infections that involve biofilms. The genetic mechanisms of this biofilm antibiotic resistance appear to fall into two general classes: innate resistance factors and induced resistance factors. Innate mechanisms are activated as part of the biofilm developmental pathway, the factors being integral parts of biofilm structure and physiology. Innate pathways include decreased diffusion of antibiotics through the biofilm matrix, decreased oxygen and nutrient availability accompanied by altered metabolic activity, formation of persisters, and other specific molecules not fitting into the above groups. Induced resistance factors include those resulting from induction by the antimicrobial agent itself. Biofilm antibiotic resistance is likely manifested as an intricate mixture of innate and induced mechanisms. Many researchers are currently trying to overcome this extreme biofilm antibiotic resistance by developing novel therapies aimed at disrupting biofilms and killing the constituent bacteria. These studies have led to the identification of several molecules that effectively disturb biofilm physiology, often by interrupting bacterial quorum sensing. In this manner, manipulation of innate and induced resistance pathways holds much promise for treatment of biofilm infections.