Acinetobacter baumannii is a critical nosocomial pathogen whose persistence is closely linked to biofilm-associated survival. This narrative review critically examined structural determinants, regulatory networks, evidence strength, and intervention points across the biofilm lifecycle. Reproducible targeted searches of PubMed, Scopus, and Web of Science used no lower date limit and were last conducted in April 2026, prioritizing mechanistic, structural, clinical-isolate, and in vivo evidence. The literature supports a context-dependent network in which Csu pili, Ata, and OmpA interact with BfmRS, quorum sensing, cyclic di-GMP, LeuO, and matrix-export systems. The review distinguishes genetically inherited antimicrobial resistance from reversible biofilm-associated tolerance and persistence, identifies strain- and model-dependent controversies, and maps anti-adhesion, signaling, matrix, phage, and anti-persister strategies. Because most interventions remain preclinical, biofilm control may benefit from stage-specific combinations whose penetration, toxicity, stability, and resistance risk are evaluated in clinically relevant models.