Understanding the role of drug efflux pumps in biofilms and virulence properties: Multiple potential strategies controlling bacterial infections

OBJECTIVES: This study highlights the role of efflux pumps in the resilience of bacterial biofilms and explores strategies to overcome efflux-mediated resistance in order to improve the treatment of biofilm-associated infections. METHODS: A literature-based analysis was conducted to examine the mechanisms by which efflux pumps contribute to biofilm resistance and persistence, and to evaluate natural, synthetic, and nanomaterial-based inhibitors as potential therapeutic approaches. RESULTS: Efflux pumps were identified as critical determinants of biofilm resilience, actively expelling antibiotics, biocides, and signaling molecules, thereby reducing antimicrobial efficacy. Overexpression of efflux pumps in biofilm-forming bacteria was linked to enhanced survival and chronic infection. Several natural compounds, synthetic molecules, and nanomaterials demonstrated inhibitory effects on efflux pumps, disruption of biofilm integrity, and restoration of antibiotic susceptibility. Combination therapies using efflux pump inhibitors with conventional antibiotics showed synergistic effects. CONCLUSIONS: Targeting efflux pumps provides a promising strategy to mitigate biofilm-associated resistance and virulence. Incorporating efflux pump inhibitors into therapeutic regimens may enhance patient outcomes and improve management of persistent biofilm-related infections.