Antibiotic-induced outer membrane vesicle (iOMV)-mediated biofilm inhibition and ecological disadvantage of Elizabethkingia anophelis under inappropriate antibiotic exposure.

Proposed model based on experimental findings. E. anophelis coexists with other nosocomial pathogens without antibiotic stress and contributes to polymicrobial biofilm formation, offering mutual protection within a shared matrix. However, under treatment with inappropriate or sub-inhibitory concentrations of antibiotics, including imipenem, E. anophelis undergoes stress-induced OMV blebbing, producing large quantities of iOMVs. iOMVs inhibit biofilm formation in E. anophelis and competing species, including Acinetobacter baumannii, but not in other pathogens. Consequently, E. anophelis may lose biofilm-mediated protection and become ecologically disadvantaged, while other biofilm-producing pathogens may gain a survival advantage in clinical settings.