Biofilms in Urological Infections: Mechanisms, Diagnostic Advances, and Innovative Management Strategies
Archives of Men's Health,
Vol. 9 No. 1 (2025),
9 November 2025
,
Page e4
Abstract
Urinary tract infections (UTIs) remain one of the most prevalent infectious diseases worldwide, posing significant clinical and economic challenges. The formation of bacterial biofilms, particularly on indwelling urological devices, is a key factor contributing to the persistence, recurrence, and resistance of infections to conventional antibiotics. Biofilms exhibit complex architectures, altered bacterial phenotypes, and the presence of dormant “persister” cells, all of which limit drug penetration and compromise treatment efficacy. Recent advances in diagnostic approaches, including molecular assays, imaging techniques, and precision metagenomics, have led to improved detection of biofilm-associated pathogens and the ability to assess their pathogenic potential. Therapeutic innovations such as nanotechnology-based drug delivery systems, biofilm-inhibiting compounds, phage therapy, microbiome modulation, and AI-driven precision medicine show promise in overcoming traditional treatment limitations. These strategies emphasize patient-specific interventions and targeted antimicrobial approaches, which are crucial for reducing recurrence, minimizing resistance, and improving clinical outcomes. Integrating biofilm research into routine clinical practice, along with fostering interdisciplinary collaboration among clinicians, microbiologists, and biomedical engineers, is essential to advance diagnostics, therapeutics, and preventive strategies for biofilm-associated urological infections.
- biofilms
- Urinary Tract Infections
- Antimicrobial Resistance
- Microbiome
- Precision Medicine
- Catheter-Related Infections
- Drug Resistance
How to Cite
References
1. Öztürk, R. and A. Murt, Epidemiology of urological infections: a global burden. World J Urol, 2020. 38(11): p. 2669-2679.
2. Medina, M. and E. Castillo-Pino, An introduction to the epidemiology and burden of urinary tract infections. Ther Adv Urol, 2019. 11: p. 1756287219832172.
3. Yang, X., et al., Disease burden and long-term trends of urinary tract infections: A worldwide report. Front Public Health, 2022. 10: p. 888205.
4. Afshar, S., et al., Investigating the pattern of drug resistance among bacteria isolated from women suffering from urinary tract infections in Savojbolagh. 2023.
5. Iskandar, K., et al., Economic Burden of Urinary Tract Infections From Antibiotic-Resistant Escherichia coli Among Hospitalized Adult Patients in Lebanon: A Prospective Cohort Study. Value Health Reg Issues, 2021. 24: p. 38-46.
6. Olaimat, A.N., et al., A Review of Bacterial Biofilm Components and Formation, Detection Methods, and Their Prevention and Control on Food Contact Surfaces. Microbiology Research, 2024. 15(4): p. 1973-1992.
7. Vani, S., K. Vadakkan, and B. Mani, A narrative review on bacterial biofilm: its formation, clinical aspects and inhibition strategies. Future Journal of Pharmaceutical Sciences, 2023. 9(1): p. 50.
8. Zhao, A., J. Sun, and Y. Liu, Understanding bacterial biofilms: From definition to treatment strategies. Frontiers in cellular and infection microbiology, 2023. 13: p. 1137947.
9. Lichtenberg, M., et al., What's in a name? Characteristics of clinical biofilms. FEMS Microbiol Rev, 2023. 47(5).
10. Alshaikh, S.A., et al., Correlation between antimicrobial resistance, biofilm formation, and virulence determinants in uropathogenic Escherichia coli from Egyptian hospital. Ann Clin Microbiol Antimicrob, 2024. 23(1): p. 20.
11. Rafighi, D. and J. Taghinejad, Review on Pathogenicity and Drug-Resistance Mechanisms at Acinetobacter Baumannii.
12. Soto, S.M., Importance of biofilms in urinary tract infections: new therapeutic approaches. Advances in biology, 2014. 2014(1): p. 543974.
13. Delcaru, C., et al., Microbial Biofilms in Urinary Tract Infections and Prostatitis: Etiology, Pathogenicity, and Combating strategies. Pathogens, 2016. 5(4).
14. Pinto, H., M. Simões, and A. Borges, Prevalence and Impact of Biofilms on Bloodstream and Urinary Tract Infections: A Systematic Review and Meta-Analysis. Antibiotics (Basel), 2021. 10(7).
15. Sharma, S., et al., Microbial Biofilm: A Review on Formation, Infection, Antibiotic Resistance, Control Measures, and Innovative Treatment. Microorganisms, 2023. 11(6): p. 1614.
16. Agarwal, H., et al., Capturing the micro-communities: insights into biogenesis and architecture of bacterial biofilms. BBA advances, 2025. 7: p. 100133.
17. Sahoo, K. and S. Meshram, Biofilm Formation in Chronic Infections: A Comprehensive Review of Pathogenesis, Clinical Implications, and Novel Therapeutic Approaches. Cureus, 2024. 16(10): p. e70629.
18. Lv, C., et al., Formation, architecture, and persistence of oral biofilms: recent scientific discoveries and new strategies for their regulation. Frontiers in Microbiology, 2025. 16: p. 1602962.
19. Rafighi, D. and Y. Anzabi, Frequency of OXA-48 and OXA-23 Genes in Strains Resistant to Cephalosporins and Carbapenem Antibiotics in Acinetobacter baumannii Isolated from One of the Public Hospitals in Tabriz, Iran. 2024.
20. Wang, X., et al., Biofilm formation: mechanistic insights and therapeutic targets. Molecular Biomedicine, 2023. 4(1): p. 49.
21. Almatroudi, A., Biofilm Resilience: Molecular Mechanisms Driving Antibiotic Resistance in Clinical Contexts. Biology, 2025. 14(2): p. 165.
22. Ullah, S., et al., Mechanistic insights and therapeutic innovations in engineered nanomaterial-driven disruption of biofilm dynamics. RSC advances, 2025. 15(29): p. 23187-23222.
23. Govindarajan, D.K. and K. Kandaswamy, Virulence factors of uropathogens and their role in host pathogen interactions. Cell Surf, 2022. 8: p. 100075.
24. Klein, R.D. and S.J. Hultgren, Urinary tract infections: microbial pathogenesis, host-pathogen interactions and new treatment strategies. Nat Rev Microbiol, 2020. 18(4): p. 211-226.
25. Farizano, J.V., et al., Virulence traits and bacterial interactions within the complex microbial population in urinary double-J catheters. Frontiers in Microbiology, 2025. 16: p. 1674834.
26. García-García, J.D., et al., Pathogenesis and Immunomodulation of Urinary Tract Infections Caused by Uropathogenic Escherichia coli. Microorganisms, 2025. 13(4): p. 745.
27. Pelling, H., et al., Bacterial biofilm formation on indwelling urethral catheters. Lett Appl Microbiol, 2019. 68(4): p. 277-293.
28. Trautner, B.W. and R.O. Darouiche, Role of biofilm in catheter-associated urinary tract infection. Am J Infect Control, 2004. 32(3): p. 177-83.
29. Lila, A.S.A., et al., Biofilm Lifestyle in Recurrent Urinary Tract Infections. Life (Basel), 2023. 13(1).
30. Gaglione, R., et al., Novel Antimicrobial Strategies to Prevent Biofilm Infections in Catheters after Radical Cystectomy: A Pilot Study. Life (Basel), 2022. 12(6).
31. Magana, M., et al., Options and Limitations in Clinical Investigation of Bacterial Biofilms. Clin Microbiol Rev, 2018. 31(3).
32. Tenke, P., et al., The role of biofilm infection in urology. World journal of urology, 2006. 24(1): p. 13-20.
33. Almatroudi, A., Investigating Biofilms: Advanced Methods for Comprehending Microbial Behavior and Antibiotic Resistance. FBL, 2024. 29(4).
34. Silva, N.B.S., L.A. Marques, and D.D.B. Röder, Diagnosis of biofilm infections: current methods used, challenges and perspectives for the future. J Appl Microbiol, 2021. 131(5): p. 2148-2160.
35. Dutta, B., et al., Multi-omics technology in detection of multispecies biofilm. The Microbe, 2024. 4: p. 100128.
36. Samenezhad, S., et al., Proteomics in Chronic Prostatitis: Biomarker Discovery, Molecular Pathways, and Emerging Targets for Precision Medicine. Archives of Men’s Health, 2024. 8(1): p. e9.
37. Sun, J., K. Cheng, and Y. Xie, Urinary Tract Infections Detection with Molecular Biomarkers. Biomolecules, 2024. 14(12): p. 1540.
38. Liu, H.Y., E.L. Prentice, and M.A. Webber, Mechanisms of antimicrobial resistance in biofilms. npj Antimicrobials and Resistance, 2024. 2(1): p. 27.
39. Khalil, M.A., et al., Antibiotic Resistance and Biofilm Formation in Enterococcus spp. Isolated from Urinary Tract Infections. Pathogens, 2022. 12(1).
40. Goneau, L.W., et al., Subinhibitory antibiotic therapy alters recurrent urinary tract infection pathogenesis through modulation of bacterial virulence and host immunity. mBio, 2015. 6(2).
41. Subramanian, P., et al., Antiobiotic resistance pattern of biofilm-forming uropathogens isolated from catheterised patients in Pondicherry, India. Australas Med J, 2012. 5(7): p. 344-8.
42. Dzalamidze, E., et al., Discovery of Biofilm-Inhibiting Compounds to Enhance Antibiotic Effectiveness Against M. abscessus Infections. Pharmaceuticals, 2025. 18(2): p. 225.
43. Xie, Y., et al., Nanomaterial-enabled anti-biofilm strategies: new opportunities for treatment of bacterial infections. Nanoscale, 2025. 17(10): p. 5605-5628.
44. Ferraz, M.P., Advanced Nanotechnological Approaches for Biofilm Prevention and Control. Applied Sciences, 2024. 14(18): p. 8137.
45. Seo, H., et al., Emerging insights into microbiome therapeutics for urinary tract infections: a narrative review. Urogenital Tract Infection, 2025. 20(1): p. 4-16.
46. Al-Anany, A.M., et al., Phage Therapy in the Management of Urinary Tract Infections: A Comprehensive Systematic Review. Phage (New Rochelle), 2023. 4(3): p. 112-127.
47. Nissanka, M.C., et al., Advances in experimental bladder models: bridging the gap between in vitro and in vivo approaches for investigating urinary tract infections. BMC Urology, 2024. 24(1): p. 206.
48. Gupta, K., et al., Urinary tract infection in adults: gaps in current guidelines - opinions from an international multidisciplinary panel and relevance to clinical practice. BMC Proc, 2025. 19(Suppl 16): p. 18.
49. Almas, S., et al., Advantage of precision metagenomics for urinary tract infection diagnostics. Frontiers in Cellular and Infection Microbiology, 2023. 13: p. 1221289.
50. da Silva, R.A.G., I. Afonina, and K.A. Kline, Eradicating biofilm infections: an update on current and prospective approaches. Curr Opin Microbiol, 2021. 63: p. 117-125.
51. Allami, R.H. and M.G. Yousif, Integrative AI-driven strategies for advancing precision medicine in infectious diseases and beyond: a novel multidisciplinary approach. arXiv preprint arXiv:2307.15228, 2023.
52. Samenezhad, S. and D. Rafighi, The role of artificial intelligence in advancing urologic care: From diagnostics to therapeutics. Surgery in Practice and Science, 2026. 24: p. 100322.
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