**Author details**

(MC) formation surrounded by protective secreted molecules known as the matrix of extra polymeric substances (EPS) having up to 97% water as the main component [97] and (c) dispersal including shedding of PB or MC from the mature biofilm [97]. The last phase can encourage further biofilm colonization of the host which can eventually benefit the bacteria with a limited supply of nutrients and waste accumulation [97]. Importantly, the transition from planktonic growth to surface life is triggered by several environmental signals known as various stresses for the bacteria based on their ecological niche [98]. These include UV radiation, pH changes, oxygen tension, osmolarity, iron availability, temperature, nutrient supply and desiccation [98], which may disrupt their fundamental functions such as growth and survival capability. The environmental indications, however, vary significantly between organisms. Thus, *P. aeruginosa* will form biofilms under most circumstances [99, 100] while *E. coli* O157:H7 produce a biofilm under low-nutrient

Recent advances in biofilm research have proven its connection to various path-

The constant increase in AMR is a significant public health concern that needs to be addressed now. This review starts with an introduction to AMR followed by the threats from the clinically important MDR pathogens and their rise. With the existing management strategies for MDR by the scientists still ongoing, we have taken up this study to propose an integrated approach to deal with MDR threats. Thus, the review ends with new connections of important bacterial components

The authors acknowledge the support of Sunway University, Selangor, Malaysia for providing the computational facilities and wishes to thank Hend Salah for the valuable contribution in developing the artwork for the concept provided.

ways and proteins [61]. For instance, defects in MDR EP activity reduced the biofilm formation and thus, EP inhibitors have been employed as a promising biofilm inhibition approach for strains of *E. coli* and *Klebsiella* [102], *Salmonella* [103], *P. aeruginosa* and *S. aureus* [104]. However, certain other reports show that despite the elimination of planktonic cells through pharmacological intervention, the sessile forms are resistant and continue to proliferate within the biofilm [105]. This is more of prominence on abiotic surfaces [95], such as catheters [106], contact lenses [107] and prosthetic cardiac valves [108]. Thus, alginate mucoids, with EPS overexpression, from *P. aeruginosa* species isolated from cystic fibrosis patients, were found to improve AMR by promoting the biofilm formation [109].

conditions only [101].

*Antimicrobial Resistance - A One Health Perspective*

**5. Conclusion**

with MDR.

**Acknowledgements**

**Conflict of interest**

**14**

The authors declare no conflict of interest.

Shama Mujawar1†, Bahaa Abdella1,2† and Chandrajit Lahiri<sup>1</sup> \*

1 Department of Biological Sciences, Sunway University, Petaling Jaya, Selangor, Malaysia

2 Faculty of Aquatic and Fisheries Sciences, Kafrelsheikh University, Egypt

\*Address all correspondence to: chandrajitl@sunway.edu.my

† These authors have contributed equally to the work.

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
