Discerning the role of polymicrobial biofilms in the ascent, prevalence, and extent of heteroresistance in clinical practice

Antimicrobial therapy is facing a worrisome and underappreciated challenge, the phenomenon of heteroresistance (HR). HR has been gradually documented in clinically relevant pathogens (e.g. Pseudomonas aeruginosa, Staphylococcus aureus, Burkholderia spp., Acinetobacter baumannii, Klebsiella pneumoniae, Candida spp.) towards several drugs believed to complicate clinical picture chronic infections. This type infections are typically mediated by polymicrobial biofilms, wherein microorganisms inherently display wide range physiological states, distinct metabolic pathways, diverging refractory levels stress responses, complex network chemical signals exchange. review aims provide an overview on relevance, prevalence, implications settings. Firstly, related terminologies resistance, tolerance, persistence), sometimes misunderstood overlapped, were clarified. Factors generating misleading definitions also uncovered. Secondly, recent incidences reported different antimicrobials annotated. The potential mechanisms underlying such occurrences further elucidated. Finally, link between biofilms was discussed. focus recognize presence heterogeneous resistance within most as well relevance infectious diseases their role spreading. These topics subject critical appraisal, gaining insights into ascending antimicrobial spreading, which could ultimately help designing effective therapeutic options.