Lactobacillus strains in the prevention and disruption of antimicrobial-resistance in pathogenic microbial biofilms: a review of mechanisms and clinical perspective.

The growing prevalence of antibiotic resistance, coupled with the heightened drug tolerance exhibited by biofilm-associated infections, represents a major public health challenge and demands the development of innovative therapeutic interventions. Probiotics, particularly the genus Lactobacilli, offer an effective, multifaceted strategy that targets biofilm-associated pathogens through competitive exclusion, secretion of antimicrobial metabolites, disruption of quorum sensing, enzymatic degradation of extracellular polymeric substances, and host immunomodulation. Studies demonstrate robust efficacy of probiotics against clinically challenging pathogens, including methicillin-resistant Staphylococcus aureus, multidrug-resistant Pseudomonas aeruginosa, Clostridioides difficile, Helicobacter pylori, and pathogenic Escherichia coli. Postbiotics, particularly cell-free supernatants and purified bacteriocins, offer standardized, shelf-life probiotic products. Notably, synergistic combinations with conventional antibiotics, phytochemicals, or bacteriophages enhance antimicrobial activity while enabling dose-reduction strategies to mitigate the development of resistance. However, compelling preclinical evidence, clinical translation remains constrained by the imperative for strain-specific characterization, methodologically robust randomized controlled trials, and comprehensive safety validation. This study critically mentions current mechanisms underlying Lactobacillus-mediated anti-biofilm strategies and identifies priority research essential to accelerating clinical application.