Biofilms in human and veterinary infections: a central link in One Health frameworks

Antimicrobial resistance (AMR) is widely recognized as a One Health (OH) challenge requiring coordinated action across the human, veterinary, and environmental sectors. However, current frameworks primarily focus on antimicrobial use, transmission pathways, and resistant organisms, while largely overlooking the ecological source from which resistance develops. Biofilms, the predominant lifestyle of many clinically relevant microorganisms, represent such a source. Their extracellular matrix and phenotypic heterogeneity contribute to antimicrobial tolerance, while their spatial arrangement facilitates horizontal gene transfer, making biofilms reservoirs for AMR evolution. Biofilm-associated infections are common in both human and veterinary medicine, including surgical site infections (SSIs), chronic wounds, periodontal disease, and device-related infections. Despite similarities in causative pathogens, infection biology, antimicrobial exposure, and clinical management, these infections are largely investigated independently. Opportunities to identify shared biological mechanisms and develop cross-sector preventive, diagnostic, and therapeutic strategies remain unexplored. This opinion article proposes to implement the OH biofilm framework, recognizing biofilms as shared ecological and evolutionary entities across human and veterinary medicine. SSIs and periodontitis are used as illustrative examples to demonstrate the similarities between the two sectors. Integrating biofilm biology into OH surveillance, research, prevention, diagnostics, and antimicrobial stewardship may provide a more mechanistic and effective framework for combating AMR.