Biofilms are structured microbial communities that adhere to biotic and abiotic surfaces embedded in an autonomous extracellular matrix. These structures contribute to persistent infections, especially in patients with indwelling medical devices, due to their resistance to antimicrobial agents; they have evolved to evade host immune responses. Despite advances in antimicrobial therapies, biofilm-associated infections remain a major challenge in clinical infectious diseases. This perspective explores the underlying mechanisms of biofilm resilience and immune evasion, emphasizing the limitations of conventional treatments and the need to develop pre-emptive measures that focus on preventing biofilm formation rather than implementing a treatment. This work discusses emerging strategies, such as quorum-sensing inhibition, hormonal modulation, matrix-degrading enzymes, anti-adhesive surface modifications, and nanotechnology-based drug delivery, that offer promising avenues to disrupt biofilm formation and maturation. Also offers a shift from the paradigm, looking into proactive prevention rather than treatment, emphasizing clinical translation, scalability, and biocompatibility. Embedding these strategies into routine care could significantly reduce healthcare-associated infections, improve patient outcomes, and mitigate the development of antimicrobial resistance. Our analysis highlights biofilm prevention as a critical frontier in the future of infectious disease management.

Introduction: The Kingdom of Saudi Arabia has limited data on enteropathogenic Escherichia coli (EPEC). Therefore, this study was undertaken to contribute to EPEC surveillance and investigate the molecular epidemiology of EPEC strains that have been implicated in human infection in King Fahd Hospital of the University (KFHU) between 2013 and 2014 in the Eastern Province of Saudi Arabia. Methods: A total of 60 non-duplicate E. coli isolates associated with human gastroenteritis were included in this study. They were characterized using PCR to determine virulence genes, antimicrobial resistance patterns, and enterobacterial repetitive intergenic consensus (ERIC-PCR). Results: Among the 60 strains, 20% of those examined were positive for the intimin eae and bfpA genes and identified as typical EPEC (tEPEC). Furthermore, 44 of E. coli strains tested positive for the eae gene only and revealed a high occurrence rate of 73.3% of atypical EPEC (aEPEC) within the overall examined strains. All strains were positive for the EAST1 gene, and none tested positive for the stx gene. More than 70% of EPEC strains were multi-drug resistant (MDR) and aEPEC strains with the highest proportion of this feature of MDR. ERIC-PCR fingerprint revealed a total of 19 ERIC types with eight related distinct clusters and a similarity rate cut-off with ≥ 90% homology from the identified isolates. Conclusion: A high antibiotic resistance rate was reported for first-line antibiotics, such as ampicillin, tetracycline, nalidixic acid, trimethoprim-sulfamethoxazole, noroxin, and ciprofloxacin.

Background: Urinary tract infection (UTI) caused by V. cholerae is rare and less common. V. cholerae is a Gram-negative bacterium motile using single polar flagellum and, originally, is a waterborne microbe found in aquatic and estuarine environments. Toxigenic V. cholerae is well-known as a causative agent of acute and excessive watery diarrhea after ingesting food and water contaminated with this bacterium. Case Presentation: A 27-year-old male patient presented to the emergency department on 17th July 2021 with burning micturition, normal vital signs, and no fever, vomiting, or diarrhea. In 2017, the patient complained of short stature and vitamin D deficiency. He was on human growth hormone from January 2018 till October 2019. The diagnosis was V. cholerae Non-O1/non-O139 urinary tract infection (UTI). Considering a urinary tract infection, empirical treatment with Lornoxicam and Ciprofloxacin was initiated, while the result of urine culture was still pending. The patient was discharged on the same day and without any complications. Conclusion: V. cholerae non-O1/non-O139 is primarily a marine inhabitant and is associated with sporadic cases resulting in cholera-like diarrhea after consumption of contaminated seafood and exposure to seawater. Extraintestinal infection associated with this bacterium should no longer be ignored as this change in the behavior of cholera bacteria mechanism of pathogenicity might be related to some associated virulence genes.

Non-O1, non-O139 Vibrio cholerae (NOVC) extraintestinal infections are rare, but recently, several clinical incidents have been reported worldwide. Toxigenic V. cholerae is a well-known etiological agent of cholera, responsible for acute dehydrating watery diarrhea. Outbreaks occur in an epidemic seasonal pattern, particularly in countries with poverty and poor sanitation. Strains of NOVC are usually not involved in causing the epidemic or pandemic outbreaks seen with potential strains of V. cholerae serogroup O1 and O139. However, they can still cause severe sporadic cases of intestinal as well as extraintestinal infections. In this study, we investigated a case of extraintestinal infections associated with the NOVC serogroup isolated from a deep closed wound abscess. The isolate was screened for the presence of three major virulence genes, toxR, ctxA, and tcpA. The strain tested positive for the toxR gene encoding the regulatory protein and cholera toxin (ctx) gene and tested negative for the toxin-coregulated pilus (TCP) gene, which is essential for the colonization of the human intestine, causing the severe diarrheal disease cholera. To the best of our knowledge, this is the first case of extraintestinal infection caused by toxigenic Vibrio cholerae non-O1/non-O139 in a hospitalized patient in Saudi Arabia.

Background and Aim: The global expansion of antimicrobial resistance (AMR), particularly due to extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, represents a critical threat to food safety and public health. Imported meat products are increasingly recognized as potential vehicles for the transboundary dissemination of multidrug-resistant (MDR) bacteria. However, data on the occurrence and molecular characteristics of ESBL-producing E. coli in imported frozen beef in Saudi Arabia remain limited. This study aimed to determine the prevalence, AMR profiles, and ESBL gene distribution among E. coli isolated from retail imported frozen beef. Materials and Methods: A total of 78 imported frozen boneless beef samples were collected from retail shops and supermarkets in Dammam and Al Khobar, Eastern Province, Saudi Arabia. E. coli isolation was performed using Enterobacteriaceae enrichment broth followed by CHROMagar™ E. coli. Presumptive isolates were screened on CHROMagar™ ESBL and subjected to antimicrobial susceptibility testing against 21 antimicrobials using the disc diffusion method. Phenotypic confirmation of ESBL production was conducted using E-test ESBL strips. Molecular detection of ESBL-encoding genes (blaTEM, blaSHV, blaCTX-M-1, blaCTX-M-9, and blaCTX-M-15) was performed by polymerase chain reaction. Results: From 78 beef samples, 390 E. coli isolates were recovered, of which 361 (92.5%) were presumptive ESBL producers on CHROMagar™ ESBL. Phenotypic confirmation showed that 319/361 (88.3%) isolates were ESBL-producing E. coli. Molecular analysis detected β-lactamase genes in 324/361 (89.7%) isolates, with blaCTX-M-1 and blaCTX-M-15 each identified in 87.5% of isolates. High resistance rates were observed to ampicillin (99.4%), cephalothin (97.2%), cephalexin (91.4%), ceftriaxone (81.9%), and cefotaxime (73.9%). MDR was detected in 97.2% of isolates. Conclusion: Retail imported frozen beef in Saudi Arabia harbors an exceptionally high burden of MDR ESBL-producing E. coli, predominantly driven by CTX-M-1 and CTX-M-15 enzymes. These findings indicate that international beef supply chains may act as significant reservoirs for high-risk ESBL determinants, underscoring the need for strengthened surveillance, regulatory control, and One Health-based interventions to limit foodborne dissemination of AMR. Keywords: antimicrobial resistance, beef safety, Escherichia coli, extended-spectrum beta-lactamase, foodborne pathogens, imported meat, multidrug resistance, One Health.