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<p>Chronic rhinosinusitis (CRS) is a multifactorial inflammatory condition of the sinonasal mucosa, with bacterial biofilms increasingly recognized as key contributors to its persistence and treatment resistance. This review evaluates various studies that implicate bacterial biofilms in the pathophysiology of CRS, and the effect of potential antimicrobial agents that act on them. Following the PRISMA guidelines, a comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library up to August 2025. Eligible studies included those demonstrating biofilm formation in CRS patients and/or evaluating antimicrobial agents against biofilm-forming bacteria. <i>Staphylococcus aureus</i> and <i>Pseudomonas aeruginosa</i> were the most consistently reported biofilm-forming organisms in CRS. Biofilm architecture was predominantly examined through direct visualization techniques such as SEM, TEM, and CLSM. A range of novel antibiofilm strategies including povidone-iodine formulations, bacteriophages, antimicrobial peptides, nitric oxide–releasing platforms, nanoparticles, probiotics, and natural products such as manuka honey—demonstrated promising in vitro activity. Encouraging results were also obtained in animal models (e.g., sheep sinusitis model), although most compounds were tested only at the preclinical stage. To date, clinical trials have been conducted only for colloidal silver particles and manuka honey, but findings remain limited and inconclusive. There remains an urgent need for cost-effective biofilm detection tools and well-designed clinical studies to translate emerging antibiofilm strategies into routine CRS management.</p>

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Systematic Review of Biofilms and Potential Antibiofilm Agents in Chronic Rhinosinusitis

  • 期刊论文

  • 发表日期：

    2025年11月17日

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  • Abhilasha Karunasagar,
  • Caroline DSouza,
  • Arjun Aadur Pugazhenthi,
  • Bidemi Alli

摘要

Chronic rhinosinusitis (CRS) is a multifactorial inflammatory condition of the sinonasal mucosa, with bacterial biofilms increasingly recognized as key contributors to its persistence and treatment resistance. This review evaluates various studies that implicate bacterial biofilms in the pathophysiology of CRS, and the effect of potential antimicrobial agents that act on them. Following the PRISMA guidelines, a comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library up to August 2025. Eligible studies included those demonstrating biofilm formation in CRS patients and/or evaluating antimicrobial agents against biofilm-forming bacteria. Staphylococcus aureus and Pseudomonas aeruginosa were the most consistently reported biofilm-forming organisms in CRS. Biofilm architecture was predominantly examined through direct visualization techniques such as SEM, TEM, and CLSM. A range of novel antibiofilm strategies including povidone-iodine formulations, bacteriophages, antimicrobial peptides, nitric oxide–releasing platforms, nanoparticles, probiotics, and natural products such as manuka honey—demonstrated promising in vitro activity. Encouraging results were also obtained in animal models (e.g., sheep sinusitis model), although most compounds were tested only at the preclinical stage. To date, clinical trials have been conducted only for colloidal silver particles and manuka honey, but findings remain limited and inconclusive. There remains an urgent need for cost-effective biofilm detection tools and well-designed clinical studies to translate emerging antibiofilm strategies into routine CRS management.