The mechanisms of biofilm antibiotic resistance in chronic rhinosinusitis: A review.

Chronic rhinosinusitis (CRS) is a common but burdensome ailment that is still poorly understood in terms of its pathogenesis. The existence of biofilms on the sinonasal mucosa of individuals with CRS has been proven by current biofilm identification methods. Current treatments for CRS generally include functional endoscopic sinus surgery, biofilm-removing strategies, and limited therapies that target quorum sensing (QS), patients with CRS are often resistant to antimicrobial therapy at degrees achievable by oral or intravenous administration, and even a subset of patients fail to react to either medical or surgical intervention. Multidrug-resistant Pseudomonas aeruginosa, Staphylococcus aureus, especially methicillin-resistant S. aureus, Streptococcus pneumoniae, and Haemophilus influenzae are the most commonly implicated bacteria in CRS patients, which may lead to the persistence and severity of CRS and antibiotic treatment failure via the formation of biofilms. Resistance to antibiotics is attributed to the 3-dimensional structure and QS of biofilms, and the latter describes the communication of bacteria within biofilms. A better understanding of biofilms in CRS and their contribution to the antibiotic resistance of CRS is critical for novel treatment strategies. This review mainly discusses the special structure of biofilms, QS, and their mechanisms of antibiotic resistance in order to investigate prospective anti-biofilm therapies, suggest future directions for study, and potentially refine the CRS prevention paradigm.