Background: It has been proposed that GAS may form biofilms. Biofilms are microbial
communities that aggregate on a surface, and exist within a self-produced matrix of extracellular polymeric
substances. Biofilms offer bacteria an increased survival advantage, in which bacteria persist,
and resist host immunity and antimicrobial treatment. The biofilm phenotype has long been recognized
as a virulence mechanism for many Gram-positive and Gram-negative bacteria, however very
little is known about the role of biofilms in GAS pathogenesis.
Objective: This review provides an overview of the current knowledge of biofilms in GAS pathogenesis.
This review assesses the evidence of GAS biofilm formation, the role of GAS virulence factors in
GAS biofilm formation, modelling GAS biofilms, and discusses the polymicrobial nature of biofilms
in the oropharynx in relation to GAS.
Conclusion: Further study is needed to improve the current understanding of GAS as both a monospecies
biofilm, and as a member of a polymicrobial biofilm. Improved modelling of GAS biofilm
formation in settings closely mimicking in vivo conditions will ensure that biofilms generated in the
lab closely reflect those occurring during clinical infection.