Biofilm-Associated Infections on Biomedical Implants and Control Measures

Biofilm-Associated Infections on Biomedical Implants

Authors

  • Iram Liaqat Department of Zoology, Government College University Lahore, Pakistan
  • Meer Karam Shah Department of Zoology, Government College University Lahore, Pakistan
  • Noor Muhammad Department of Zoology, Government College University Lahore, Pakistan

DOI:

https://doi.org/10.54393/fbt.v5i3.188

Keywords:

Biofilms, Biomaterials, Device-Related Infections, Implants, Nosocomial Infections

Abstract

Biofilms are bacterial colonies that adhere to surfaces, forming protective barriers against immune responses and antibiotics, which contribute to the development of chronic infections, particularly in medical implants. This study aims to investigate the factors that influence biofilm formation on medical implants and evaluate current strategies for preventing biofilm-related infections. A review of the literature on biofilm formation mechanisms, including quorum sensing and recalcitrance, was conducted, focusing on intrinsic (e.g., quorum-sensing molecules, c-di-GMP) and extrinsic factors (e.g., temperature, surface properties).  Biofilm-related infections are common in medical devices, complicating treatment and contributing to increased mortality. New strategies, including antimicrobial peptides, quorum-sensing inhibitors, and nanotechnology-based approaches, show promise in preventing biofilm formation. Surface modifications, such as antibiotic-loaded and nano-silver coatings, significantly reduce bacterial adhesion. Despite progress in biofilm prevention, further research is necessary to refine strategies for controlling implant-related infections and improving patient outcomes.

References

Patil M. Biofilm: A Life for Microorganisms with Basic Biofilm Principles. 2025. doi: 10.1039/9781837677047-00001.

Rath S, Fatma S, Das S. Unraveling the Multifaceted Role of Extracellular DNA (eDNA) of Biofilm in Bacterial Physiology, Biofilm Formation, and Matrixome Architecture. Critical Reviews in Biochemistry and Molecular Biology. 2025; May: 1-32. doi: 10.1080/10409238.2025.2497270.

Assefa M, Amare A. Biofilm-Associated Multi-Drug Resistance in Hospital-Acquired Infections: A Review. Infection and Drug Resistance. 2022; Jan: 5061-5068. doi: 10.2147/IDR.S379502.

Calais GB, Garcia GD, de Moura Júnior CF, Soares JD, Lona LM, Beppu MM, et al. Therapeutic Functions of Medical Implants from Various Material Categories with Integrated Biomacromolecular Systems. Frontiers in Bioengineering and Biotechnology. 2025; Jan 12:1509397. doi: 10.3389/fbioe.2024.1509397.

Dixit S, Gupta S, Sharma A. Surgical Devices for Biomedical Implants. In: Additive Manufacturing for Biomedical Applications: Recent Trends and Challenges. Singapore: Springer Nature Singapore. 2024; 195-218. doi: 10.1007/978-981-97-5456-4_10.

Kim Y, Shin SK, Noh J. Korea: Medical Device Regulatory System. In: Handbook of Medical Device Regulatory Affairs in Asia. Jenny Stanford Publishing. 2018; 475-511. doi: 10.1201/9780429504396-31.

Adlhart C, Verran J, Azevedo NF, Olmez H, Keinänen-Toivola MM, Gouveia I, et al. Surface Modifications for Antimicrobial Effects in the Healthcare Setting: A Critical Overview. Journal of Hospital Infection. 2018; Jul 99(3): 239-249. doi: 10.1016/j.jhin.2018.01.018.

Mishra A, Aggarwal A, Khan F. Medical Device-Associated Infections Caused by Biofilm-Forming Microbial Pathogens and Controlling Strategies. Antibiotics. 2024; Jul 13(7): 623. doi: 10.3390/antibiotics13070623.

Khatoon Z, McTiernan CD, Suuronen EJ, Mah T-F, Alarcon EI. Bacterial Biofilm Formation on Implantable Devices and Approaches to Its Treatment and Prevention. Heliyon. 2018; Dec 4: e01067. doi: 10.1016/j.heliyon.2018.e01067.

Bouhrour N, Nibbering PH, Bendali F. Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens. Pathogens. 2024; May 13(5): 393. doi: 10.3390/pathogens13050393.

Alqarni MS. Catheter-Associated Urinary Tract Infection (CAUTI) in ICU Patients. Middle East Journal of Nursing. 2021; Feb 15(1): 25-33. doi: 10.5742/MEJN2021.93799.

Song F, Koo H, Ren D. Effects of Material Properties on Bacterial Adhesion and Biofilm Formation. Journal of Dental Research. 2015; Aug 94(8): 1027-1034. doi: 10.1177/0022034515587690.

Asma ST, Imre K, Morar A, Herman V, Acaroz U, Mukhtar H, et al. An Overview of Biofilm Formation-Combating Strategies and Mechanisms of Action of Antibiofilm Agents. Life. 2022; Jul 12(8): 1110. doi: 10.3390/life12081110.

Hetta HF, Ramadan YN, Rashed ZI, Alharbi AA, Alsharef S, Alkindy TT, et al. Quorum Sensing Inhibitors: An Alternative Strategy to Win the Battle Against Multidrug-Resistant (MDR) Bacteria. Molecules. 2024; Jul 29(15): 3466. doi: 10.3390/molecules29153466.

Moayedi S, Xia W, Lundergan L, Yuan H, Xu J. Zwitterionic Polymers for Biomedical Applications: Antimicrobial and Antifouling Strategies Toward Implantable Medical Devices and Drug Delivery. Langmuir. 2024; Nov 40(47): 23125-23145. doi: 10.1021/acs.langmuir.4c02664.

Liaqat I, Muhammad N, Ara C, Hanif U, Andleeb S, Arshad M, et al. Bioremediation of Heavy Metals Polluted Environment and Decolourization of Black Liquor Using Microbial Biofilms. Molecular Biology Reports. 2023; May 50(5): 3985-3997. doi: 10.1007/s11033-023-08334-3.

Uzoma PC, Etim IIN, Okonkwo BO, Olanrele OS, Njoku DI, Kolawole SK, et al. Recent Design Approaches, Adhesion Mechanisms, and Applications of Antibacterial Surfaces. Chemical Engineering Journal Advances. 2023; Nov 16: 100563. doi: 10.1016/j.ceja.2023.100563.

Guzmán-Soto I, McTiernan C, González-Gómez M, Ross A, Gupta K, Suuronen EJ, et al. Mimicking Biofilm Formation and Development: Recent Progress in In Vitro and In Vivo Biofilm Models. iScience. 2021; May 24(5): 102443. doi: 10.1016/j.isci.2021.102443.

Damyanova T and Paunova-Krasteva T. What We Still Do not Know About Biofilms-Current Overview and Key Research Information. Microbiology Research. 2025; Feb 16(2): 46. doi: 10.3390/microbiolres16020046.

Liaqat F, Ansar W, Muhammad N, Tariq M, Nazir Z, Qamar HMG, et al. Development of Microbial Biofilms and Their Role in Device, Non-Device and Organ System Level Infections. BioScientific Review. 2025; Mar 7(1): 32-53. doi: 10.32350/bsr.72.04.

Valentini M and Filloux A. Multiple Roles of c-di-GMP Signaling in Bacterial Pathogenesis. Annual Review of Microbiology. 2019; Sep 73: 387-406. doi: 10.1146/annurev-micro-020518-115555.

Preda VG, Roberts L, Săndulescu O. Biofilms and Their Impact on Human Health: The Beauty and the Beast. In: Handbook of Molecular Biotechnology. CRC Press. 2024; 397-405. doi: 10.1201/9781003055211.

Khalid SJ, Ain Q, Khan SJ, Jalil A, Siddiqui MF, Ahmad T, et al. Targeting Acyl Homoserine Lactones (AHLs) by the Quorum Quenching Bacterial Strains to Control Biofilm Formation in Pseudomonas aeruginosa. Saudi Journal of Biological Sciences. 2021; Oct 28(10): 1673-1682. doi: 10.1016/j.sjbs.2021.10.064.

Díaz M, San Martin D, Castro M, Vera M, Guiliani N. Quorum Sensing Signaling Molecules Positively Regulate c-di-GMP Effector PelD Encoding Gene and PEL Exopolysaccharide Biosynthesis in Extremophile Bacterium Acidithiobacillus thiooxidans. Genes. 2021; Jan 12(1): 69. doi: 10.3390/genes12010069.

Kim H-S, Ham S-Y, Ryoo H-S, Kim D-H, Yun E-T, Park H-D, et al. Inhibiting Bacterial Biofilm Formation by Stimulating c-di-GMP Regulation Using Citrus Peel Extract from Jeju Island. Science of The Total Environment. 2023; May 872: 162180. doi: 10.1016/j.scitotenv.2023.162180.

Park S, Sauer K. Controlling Biofilm Development Through Cyclic di-GMP Signaling. In: Pseudomonas Aeruginosa: Biology, Pathogenesis and Control Strategies. 2022; 69-94. doi: 10.1007/978-3-031-08491-1_3.

Zack KM, Sorenson T, Joshi SG. Types and Mechanisms of Efflux Pump Systems and the Potential of Efflux Pump Inhibitors in the Restoration of Antimicrobial Susceptibility, with a Special Reference to Acinetobacter baumannii. Pathogens. 2024 Feb; 13(3): 197. doi: 10.3390/pathogens13030197.

Hajiagha MN and Kafil HS. Efflux Pumps and Microbial Biofilm Formation. Infection, Genetics and Evolution. 2023; Aug 112: 105459. doi: 10.1016/j.meegid.2023.105459.

Kostoglou D, Tsaklidou P, Iliadis I, Garoufallidou N, Skarmoutsou G, Koulouris I, et al. Advanced Killing Potential of Thymol Against a Time and Temperature Optimized Attached Listeria Monocytogenes Population in Lettuce Broth. Biomolecules. 2021 Mar; 11(3): 397. doi: 10.3390/biom11030397.

Alotaibi GF, Bukhari MA. Factors Influencing Bacterial Biofilm Formation and Development. American Journal of Biomedical Science and Research. 2021 May; 12(5): 617-626. doi: 10.34297/AJBSR.2021.12.001820.

Wang W, Cao Y, Li J, Lu S, Ge H, Pan S, et al. The Impact of Osmotic Stresses on the Biofilm Formation, Immunodetection, and Morphology of Aeromonas Hydrophila. Microbiological Research. 2023 Apr; 269: 127301. doi: 10.1016/j.micres.2023.127301.

Gomes LC and Mergulhao FJ. A Selection of Platforms to Evaluate Surface Adhesion and Biofilm Formation in Controlled Hydrodynamic Conditions. Microorganisms. 2021 Sep; 9(9): 1993. DOI: 10.3390/microorganisms9091993.

Maimaiti Z, Li Z, Xu C, Fu J, Hao L-B, Chen J-Y, et al. Host Immune Regulation in Implant-Associated Infection (IAI): What Does the Current Evidence Provide Us to Prevent or Treat IAI? Bioengineering. 2023 Mar; 10(3): 356. doi: 10.3390/bioengineering10030356.

Drobota M, Ursache S, Aflori M. Surface Functionalities of Polymers for Biomaterial Applications. Polymers. 2022 Jun; 14(12): 2307. doi: 10.3390/polym14122307.

Kaur N and Dey P. Bacterial Exopolysaccharides as Emerging Bioactive Macromolecules: From Fundamentals to Applications. Research in Microbiology. 2023 May; 174(4): 104024. doi: 10.1016/j.resmic.2022.104024.

Torres CJ, Rupp ME, Cawcutt KA. Intravascular Catheter-Related Bloodstream Infections: Contemporary Issues Related to a Persistent Problem. Infectious Disease Clinics of North America. 2024 Dec; 38(4): 641-656. doi: 10.1016/j.idc.2024.07.002.

Moriyama K, Ando T, Kotani M, Tokumine J, Nakazawa H, Motoyasu A, et al. Risk Factors Associated with Increased Incidences of Catheter-Related Bloodstream Infection. Medicine. 2022 Oct; 101(40): e31160. doi: 10.1097/MD.0000000000031160.

Dougnon VT, Sintondji K, Koudokpon CH, Houéto M, Agbankpé AJ, Assogba P, et al. Investigating Catheter-Related Infections in Southern Benin Hospitals: Identification, Susceptibility, and Resistance Genes of Involved Bacterial Strains. Microorganisms. 2023 Feb; 11(3): 617. doi: 10.3390/microorganisms11030617.

Crowe SA, Simister RL, Spence JS, Kenward PA, Van Slyke AC, Lennox P, et al. Microbial Community Compositions in Breast Implant Biofilms Associated with Contracted Capsules. PLoS One. 2021 Apr; 16(4): e0249261. doi: 10.1371/journal.pone.0249261.

del Pozo JL, Auba C. Role of Biofilms in Breast Implant Associated Infections and Capsular Contracture. In: Biofilm-based Healthcare-associated Infections. Volume II. Springer. 2014. 53-67. doi: 10.1007/978-3-319-09782-4_5.

Urwin L, Okurowska K, Crowther G, Roy S, Garg P, Karunakaran E, et al. Corneal Infection Models: Tools to Investigate the Role of Biofilms in Bacterial Keratitis. Cells. 2020Nov; 9(11): 2450. doi: 10.3390/cells9112450.

Danin P-E, Girou E, Legrand P, Louis B, Fodil R, Christov C, et al. Description and Microbiology of Endotracheal Tube Biofilm in Mechanically Ventilated Subjects. Respiratory Care. 2015 Jan; 60(1): 21-29. doi: 10.4187/respcare.02722.

Selby LM, Rupp ME, Cawcutt KA. Prevention of Central-Line Associated Bloodstream Infections: 2021 Update. Infectious Disease Clinics of North America. 2021 Dec; 35(4): 841-856. doi: 10.1016/j.idc.2021.07.004.

Beam E, Osmon D. Prosthetic Joint Infection Update. Infectious Disease Clinics of North America. 2018 Dec; 32(4): 843-859. doi: 10.1016/j.idc.2018.06.005.

Slouha E, Rood C, Burle VS, Al-Geizi H, Clunes LA, Kollias TF. Infective Endocarditis Following Aortic Valve Replacement: A Systematic Review. Cureus. 2023 Nov; 15(11): e49048. DOI: 10.7759/cureus.49048.

Klug D, Balde M, Pavin D, Hidden-Lucet F, Clementy J, Sadoul N, et al. Risk Factors Related to Infections of Implanted Pacemakers and Cardioverter-Defibrillators: Results of a Large Prospective Study. Circulation. 2007 Aug; 116(12): 1349-1355. doi: 10.1161/CIRCULATIONAHA.106.678664.

Costa D, Andreucci M, Ielapi N, Serraino GF, Mastroroberto P, Bracale UM, et al. Infection of Vascular Prostheses: A Comprehensive Review. Prosthesis. 2023 Feb; 5(1): 148-166. doi: 10.3390/prosthesis5010012.

França A. The Role of Coagulase-Negative Staphylococci Biofilms on Late-Onset Sepsis: Current Challenges and Emerging Diagnostics and Therapies. Antibiotics. 2023 Mar; 12(3): 554. doi: 10.3390/antibiotics12030554.

Becker K, Heilmann C, Peters G. Coagulase-Negative Staphylococci. Clinical Microbiology Reviews. 2014 Oct; 27(4): 870-926. doi: 10.1128/CMR.00109-13.

Wagner RK, Emmelot MP, van Trikt C, Visser CE, Peters EJG, Janssen SJ, et al. Characteristics and Outcomes of Occult Infections in Presumed Aseptic Nonunions: A Retrospective Cohort Study. Journal of Orthopaedic Trauma. 2024 Aug; 38(8): 452-458. doi: 10.1097/BOT.0000000000002822.

Wagner RK, Emmelot MP, van Trikt C, Visser CE, Peters EJ, Janssen SJ, et al. Characteristics and Outcomes of Occult Infections in Presumed Aseptic Nonunions: A Retrospective Cohort Study. Journal of Orthopaedic Trauma. 2024 Aug; 38(8): 452-8. doi: 10.1097/BOT.0000000000003017.

Smet N, Bérard X, Ljungquist O, van den Hoven P, Sörelius K. Infective Native Aneurysms of the Femoropopliteal Arteries: A Systematic Review and Pooled Analysis. Journal of Vascular Surgery. 2025 Aug; 82(2). doi: 10.1016/j.jvs.2025.08.012.

Chung MM, Chan YC, Law Y, Cheng SW. Infectious Anastomotic Pseudoaneurysm Complicating Renal Allograft: Case Report and Review of Literature. International Journal of Nephrology and Renovascular Disease. 2017 Feb; 10: 55-60. doi: 10.2147/IJNRD.S122725.

Laborde G, Bloise C, Karam G. Understanding Orthopaedic Infections: A Conceptual Approach. Orthopedic Reviews. 2024 Dec; 16: 126048. doi: 10.52965/001c.126048.

Almasri D, Dahman Y. Prosthetic Joint Infections: Biofilm Formation, Management, and the Potential of Mesoporous Bioactive Glass as a New Treatment Option. Pharmaceutics. 2023 May; 15(5): 1401. doi: 10.3390/pharmaceutics15051401.

de Mendonça Bisneto OI, de Carvalho Feitoza LPG, Hespanhol LC, Ferreira SB, Dagostin CS, Vieira RAMS, et al. Conventional Endotracheal Tubes Versus Polymer-Coated Tubes in Ventilator-Associated Pneumonia Development: A Systematic Review and Meta-Analysis. Heliyon. 2025 Dec; 11(12): e40793. doi: 10.1016/j.heliyon.2024.e40793.

Hatami H, Ghaffari Jolfayi A, Ebrahimi A, Golmohammadi S, Zangiabadian M, Nasiri MJ. Contact Lens Associated Bacterial Keratitis: Common Organisms, Antibiotic Therapy, and Global Resistance Trends: A Systematic Review. Frontiers in Ophthalmology. 2021 Dec; 1: 759271. doi: 10.3389/fopht.2021.759271.

Konduri R, Saiabhilash CR, Shivaji S. Biofilm-Forming Potential of Ocular Fluid Staphylococcus Aureus and Staphylococcus Epidermidis on Ex Vivo Human Corneas from Attachment to Dispersal Phase. Microorganisms. 2021 May; 9(6): 1124. doi: 10.3390/microorganisms9061124.

Nappi F. Advancements and Challenges in the Management of Prosthetic Valve Endocarditis: A Review. Pathogens. 2024 Nov; 13(12): 1039. doi: 10.3390/pathogens13121039.

Perrotta RE, Ronsivalle V, Minervini G, Cicciù M. Incidence of Long-Term Complications in Breast Implant "Prosthesis": A Systematic Review. Prosthesis. 2025 Mar; 7(2): 38. doi: 10.3390/prosthesis7020038.

Fernández-Ibarburu B, Díaz-Navarro M, Ibarra G, Rivera A, Hafian R, Irigoyen A, et al. Efficacy of Povidone Iodine Against Microbial Biofilms in Breast Implants with Different Textures: Results from an In Vitro Study. Frontiers in Microbiology. 2022; Mar 13: 868347. doi: 10.3389/fmicb.2022.868347.

Aksoy F, Karakoc Parlayan HN, Oncu Kurutas G, Yilmaz G. Antimicrobial Lock Therapy: A Strategy for Managing Catheter-Related Bacteremia. Antibiotics. 2025 Apr; 14(5): 461. doi: 10.3390/antibiotics14050461.

Jirofti N, Nakhaei M, Ebrahimzadeh MH, Moradi A. Review on Hydroxyapatite-Based Coatings as Antibiotic Delivery System on Bone Graft Substitution for Controlling Infection in Orthopedic Surgery. Journal of Polymers and the Environment. 2024 May; 32(5): 2517-2531. doi: 10.1007/s10924-023-03012-8.

Wall V, Nguyen TH, Nguyen N, Tran PA. Controlling Antibiotic Release from Polymethylmethacrylate Bone Cement. Biomedicines. 2021 Jan; 9(1): 26. dOI: 10.3390/biomedicines9010026.

Yehia M, Farghaly U, Naguib YW. Advanced Biodegradable-Based Formulations for the Treatment of Arthritis. Beni-Suef University Journal of Basic and Applied Sciences. 2025 Jun; 14: 68. doi: 10.1186/s43088-025-00658-2.

Visan AI and Negut I. Coatings Based on Essential Oils for Combating Antibiotic Resistance. Antibiotics. 2024 July; 13: 625. doi: 10.3390/antibiotics13070625.

Rios-Pimentel FF, Méndez-González MM, García-Rocha M. A Short Review: Hydroxyapatite Coatings for Metallic Implants. Heat Treatment and Surface Engineering. 2023 May; 5: 2202002. doi: 10.1080/25787616.2023.2202002.

Hammed V, Bankole AA, Akinrotimi O, Ayanleye O. Silver Nanoparticles (AGNPs): A Review on Properties and Behavior of Silver at the Nanoscale Level. International Journal of Science and Research Archive. 2024 July; 12: 1267-1272. doi: 10.30574/ijsra.2024.12.2.1379.

Sahoo J, Sarkhel S, Mukherjee N, Jaiswal A. Nanomaterial-Based Antimicrobial Coating for Biomedical Implants: New Age Solution for Biofilm-Associated Infections. ACS Omega. 2022 Dec; 7: 45962-45980. doi: 10.1021/acsomega.2c06211.

Abdulraof LAA and Naser HH. Synergistic Antimicrobial Activity of a Novel Synthetic Peptide and Silver Nanoparticles against Multidrug-Resistant E. Coli. International Journal of Environmental Sciences. 2025 Aug; 26: 828-853. doi: 10.3390/ijms26167832.

Hakim LK, Yari A, Nikparto N, Mehraban SH, Cheperli S, Asadi A. et al. The Current Applications of Nano and Biomaterials in Drug Delivery of Dental Implants. BMC Oral Health. 2024 Jan; 24: 126. doi: 10.1186/s12903-024-03911-9.

Xue Y, Feng X, Roberts SC, Chen X. Diamond and Carbon Nanostructures for Biomedical Applications. Functional Diamond. 2022 Dec; 1: 221-242. doi: 10.1080/26941112.2021.2013716.

Downloads

Published

2025-09-30
CITATION
DOI: 10.54393/fbt.v5i3.188
Published: 2025-09-30

How to Cite

Liaqat, I., Shah, M. K., & Muhammad, N. (2025). Biofilm-Associated Infections on Biomedical Implants and Control Measures: Biofilm-Associated Infections on Biomedical Implants. Futuristic Biotechnology, 5(3), 19–27. https://doi.org/10.54393/fbt.v5i3.188

Plaudit

Most read articles by the same author(s)