Toward precision anti-biofilm therapy for Candida: a translational perspective

Candida biofilm-associated infections remain difficult to eradicate, particularly on indwelling devices and in other high-risk settings where persistence, relapse, and antifungal failure are common. Natural compounds and nano-enabled delivery have shown promising antibiofilm effects in preclinical studies, but the evidence base remains fragmented and largely nonclinical. This Perspective proposes Precision Anti-Biofilm Therapy (PABT) as a staged translational framework that separates what is clinically actionable now from what remains investigational. Tier 1 centers on current bedside practice-rapid species identification, susceptibility testing or local resistance patterns, source control, and routine clinical parameters-without delaying sepsis care. Tiers 2-3 reserve biofilm phenotyping, candidate biomarker panels, constrained synergy testing, and nano-enabled delivery for translational research and selected refractory niches. We do not present new experimental data or claim clinical readiness. Instead, we use the existing mechanistic and preclinical literature to define a feasibility agenda: standardized assays, pharmacologic justification at the infection site, analytical validation of candidate biomarkers, early-phase feasibility studies, and pragmatic trials in high-burden scenarios such as recurrent catheter-associated candidemia, prosthetic-device infection, and multidrug-resistant C. auris settings. By reframing PABT as a research-prioritization framework rather than a ready-to-implement protocol, this Perspective aims to make the translational pathway more explicit and testable.