**Background:** Biofilms are microbial aggregation membranes formed when microorganisms attach to living or nonliving surfaces. They provide protection against environmental pressures including UV radiation, extreme pH, temperature, salinity, high pressure, malnutrition, and antibiotics. Biofilm formation is a bacterial survival mechanism, but when foodborne pathogens form biofilms, they greatly exacerbate the risk of foodborne disease infections, causing major public health risks and adverse economic consequences. The review notes that approximately 80% of persistent bacterial infections are connected to biofilms, and biofilms are the cause of approximately 60% of the world's foodborne outbreaks. In the food industry, biofilms can form on surfaces such as stainless steel, polyethylene, wood, glass, polypropylene, and rubber, and can develop in minutes to days.
**Methods:** This is a narrative review that synthesizes existing literature on bacterial biofilm formation, the problems associated with biofilms in the food industry, common foodborne pathogens in biofilms, and current and emerging strategies for biofilm elimination or control. The review covers biofilm formation mechanisms including the five successive steps: reversible attachment, irreversible adhesion, early development of biofilm structure, biofilm maturation, and cell separation and diffusion. It discusses quorum sensing (QS) as a key regulatory mechanism, noting that different bacteria secrete different signal molecules such as acylated homoserine lactones (AHLs) by Gram-negative bacteria, autoinducing peptides (AIPs) by Gram-positive bacteria, and autoinducer-2 (AI-2) by both.
**Key Results:** The review identifies five major foodborne pathogens of concern: (1) Listeria monocytogenes, a gram-positive pathogen with high fatality and hospitalization rates, which had the highest contamination rate in China's food industry at approximately 20%; (2) Salmonella enterica, responsible for approximately 85% of foodborne illnesses, with over 2500 known serum variants; (3) Staphylococcus aureus, which colonizes 30% to 50% of healthy people and has been classified by the WHO as a high-priority antibiotic-resistant species; (4) Pseudomonas aeruginosa, designated by WHO in 2017 as requiring high-priority research, which is the most frequent pathogen in hospital-associated infections and the second-most frequent cause of ventilator-associated pneumonia in the United States; and (5) Escherichia coli, with pathogenic strains including EHEC O157:H7 that can cause haemolytic uraemic syndrome. The review notes that multispecies biofilms demonstrate greater resistance to disinfectants than single-species biofilms. Current control strategies fall into three categories: modifying abiotic surface features, regulating signalling pathways to inhibit biofilm formation, and applying external forces to eradicate biofilms. Traditional disinfectants include quaternary ammonium compounds, hypochlorites, peroxides, chloramines, iodine, ozone, aldehydes, and phenols. Emerging strategies include enzyme treatments, phage treatments, pulsed ultraviolet light, steam heat treatment, cold plasma technologies, electron beam irradiation, 405 nm irradiation, ozone, ultrasound, and gaseous chlorine dioxide.
**Clinical Implications:** Biofilm formation by foodborne pathogens poses substantial challenges to both food safety and clinical medicine. In healthcare settings, biofilms persist on medical devices and patient tissues, causing persistent infections that are difficult to treat. Pseudomonas aeruginosa biofilms in cystic fibrosis patients are typically incurable and ultimately fatal. Staphylococcus aureus biofilms show decreased sensitivity to antibiotics including vancomycin, contributing to the emergence of MRSA strains. The review emphasizes that understanding biofilm formation mechanisms and signalling pathway regulation could help identify novel targets for developing effective antibiofilm agents. Future research directions include regulating osmotic pressure within biofilms, developing combined technologies that integrate two or more control methods, and exploring natural biological agents for biofilm inhibition and quorum sensing disruption. The authors stress that a multidisciplinary approach will be required for future biofilm control research.