Abstract
Biofilms have been implicated in a variety of noso-comial infections associated with medical devices, hospital equipment, and other hard surfaces. In addition, household and workplace surfaces such as sinks, countertops, toilets, and cutting boards can act as reservoirs. This study's objective was to identify and evaluate literature reporting resistance to antimicrobial agents in biofilm populations. These review findings suggest that the research evaluating resistance in biofilms could be grouped into the following three mechanisms: (1) physicochemical barriers; (2) biological factors; and (3) phenotypic changes. Current research has identified potential mechanisms of antimicrobial resistance, but there is no clear evidence supporting any one mechanism. Moreover, no reported studies examine the potential impact of biofilms on biosafety practices and the public health risk of infectious diseases from biofilms in healthcare facilities and the workplace environment. Future research directions in biofilms are likely to focus on: (a) imaging of biofilms in situ, (b) in vitro and in vivo models of biofilms, (c) genetic, metabolic, and immunologic probes for real-time analysis, (d) antimicrobial resistance in multispecies biofilms, and (e) identification and characterization of phenotypic modifications. In our assessment, these studies will provide the basis to develop guidelines for biofilm-related biosafety and public health risk assessment.