Antibiyotik Direnci, Biyofilm ve Konak Fizyolojisi: Enfeksiyon Tedavisinde Yeni Savaş Alanı
Synopsis
Antibiotic resistance is a major public health concern that increasingly complicates the treatment of bacterial infections. However, treatment failure cannot be explained by bacterial resistance mechanisms alone. Biofilm formation and the physiological conditions of infected tissues can alter bacterial behavior, reduce antibiotic effectiveness, and contribute to persistent or recurrent infections. Within biofilms, extracellular matrices, metabolic heterogeneity, and persister cells promote antibiotic tolerance even in the absence of genetic resistance. These mechanisms are particularly important in catheter-associated infections, prosthetic joint infections, chronic wounds, and chronic lung infections. Host microenvironmental factors, including oxygen availability, pH, nutrient limitation, and ionic balance, interact with immune responses and bacterial metabolism to influence treatment outcomes. Immunometabolic changes in host cells also affect inflammation and pathogen clearance. Consequently, conventional antimicrobial susceptibility tests may not fully predict clinical responses, particularly in biofilm-associated infections. Emerging strategies, including antibiofilm agents, bacteriophage and endolysin therapies, quorum-sensing inhibitors, and host-directed interventions, offer promising complementary approaches, although further clinical evidence is needed. This chapter examines the interactions among antibiotic resistance, biofilms, and host physiology, emphasizing the importance of an integrated approach to infection management.
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