Biofilm-Associated Infections on Medical Devices: Mechanisms, Emerging Technologies, and Translational Strategies

Biofilms represent one of the most persistent and clinically significant challenges in healthcare-associated infections. These structured microbial communities, encased in self-produced extracellular polymeric substances (EPS), colonize medical devices such as catheters, prosthetic implants, orthopedic hardware, and surgical instruments, accounting for the majority of chronic and device-associated infections worldwide. Their dense architecture and protective matrix dramatically reduce the efficacy of conventional antimicrobials and shield resident microorganisms from host immune responses.

The molecular basis of biofilm resilience is increasingly understood to involve persister cell formation, metabolic dormancy, horizontal gene transfer, and intercellular signaling through quorum sensing. Yet translating these mechanistic insights into effective clinical interventions remains a major bottleneck. Polymicrobial biofilm communities, which frequently dominate device-associated infections, add a further layer of complexity through synergistic interactions, enhanced resistance, and altered virulence that single-species models fail to capture. Multi-omics approaches — including metagenomics, transcriptomics, and metabolomics — are now beginning to reveal the full ecological and molecular landscape of these communities, opening new diagnostic and therapeutic windows.

This Research Topic focuses specifically on the translational frontier of biofilm science in the context of medical devices. It aims to integrate expertise from microbiology, infectious disease, biomaterials science, biomedical engineering, and nanotechnology to move beyond the limitations of conventional antibiofilm strategies. Particular emphasis is placed on emerging and next-generation approaches: CRISPR-based antimicrobial tools for precision biofilm disruption, bacteriophage and phage-derived enzyme therapies, advanced biomaterials with active or responsive antibiofilm surfaces, and AI-assisted diagnostic platforms that enable earlier and more accurate detection of device colonization. Advanced imaging modalities — including confocal laser scanning microscopy, optical coherence tomography, and correlative techniques — are also highlighted as essential tools for characterizing biofilm architecture and treatment response in real time.

Ultimately, this Research Topic seeks to accelerate the development of safer, more effective, and clinically translatable interventions that reduce the global burden of medical device-related biofilm infections, with a clear emphasis on strategies that can realistically bridge the gap from bench to bedside.

We welcome original research, systematic reviews, and perspective articles addressing, but not limited to, the following themes:

Molecular mechanisms of biofilm formation, resilience, and antimicrobial tolerance on medical device surfaces
Polymicrobial biofilm dynamics and inter-species interactions in device-associated infections
Multi-omics profiling of biofilm communities: metagenomics, transcriptomics, proteomics, and metabolomics
Quorum sensing networks and their role in biofilm persistence and virulence
CRISPR-based and gene-editing approaches to biofilm disruption and resistance gene targeting
Bacteriophage therapy and phage-derived enzymes (endolysins, depolymerases) as precision antibiofilm agents
Advanced biomaterials: antifouling coatings, surface topography engineering, and stimuli-responsive antibiofilm materials
Nanotechnology-driven drug delivery systems for biofilm penetration and eradication
AI and machine learning applications in biofilm detection, risk stratification, and treatment optimization
Advanced imaging techniques for in situ biofilm characterization and monitoring
Photodynamic therapy, cold plasma, ultrasound-assisted, and other physical antibiofilm technologies
Natural and bioactive compounds as alternative or adjunct antibiofilm strategies
Translational models: bridging in vitro biofilm systems and in vivo device infection models
Clinical outcomes and antimicrobial stewardship in device-associated biofilm infections