Biosurfactants as Antibiofilm Agents for Medical Devices: Mechanisms, Evidence and Integration into Infection...

Biofilms rapidly form on medical devices such as urinary catheters and surgical materials. These biofilms compromise patient safety and undermine infection prevention and control (IPC). Biofilms also reduce the effectiveness of antibiotics and disinfectants. As a result, they increase healthcare-associated infections and increase costs through device failure and the need for maintenance or replacement. Researchers are increasingly exploring biosurfactants (BSs) as surface coatings and cleaning additives to prevent microbial attachment and disrupt early biofilm formation on medical devices and healthcare-related surfaces. This review examines the translational potential of biosurfactants as preventive, disruptive, and adjunctive antibiofilm agents for medical devices and healthcare-related surfaces. Literature evidence on glycolipids (rhamnolipids, sophorolipids) and lipopeptides (surfactin) from static, flow-based, and microfluidic in vitro models that used clinically relevant materials, such as silicone and polydimethylsiloxane (PDMS), were examined. In our literature search, we focused on pathogens central to IPC, such as Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus spp., and Candida spp., and it was generally noted that BSs reduced microbial adhesion and delayed early biofilm formation on medical devices and healthcare-related surfaces. Significant evidence also suggests that they partially disrupt biofilms and improve antimicrobial penetration when co-applied, mainly through membrane disruption, destabilization of extracellular substances, interfering with quorum sensing, and synergistic and/or antagonistic interactions with other molecules. Their performance varied with class, formulation, hydrodynamic conditions, and microbial composition. BSs function better as preventive and adjunctive IPC tools than stand-alone antimicrobial agents and can help to reduce biofilm formation on devices and improve surface disinfection. However, translating this promise into practice demands more robust data on long-term safety, stability, and product quality.