Mathematical modelling of biofilm growth on medical implants incorporating nutrient-dependent phenotypic switching

Biofilm infections on medical implants are difficult to eradicate because insufficient nutrient availability promotes antibiotic-tolerant persister cells that survive treatment and reseed growth. Existing mathematical models usually omit nutrient-dependent phenotypic switching between proliferative and persister states. Without this mechanism, models cannot capture how environmental conditions control the balance between active growth and dormancy, which is central to biofilm persistence. We present a continuum model that couples nutrient transport with the dynamics of proliferative bacteria, persisters, dead cells and extracellular polymeric substances. The switching rates between proliferative and persister phenotypes depend on local nutrient concentration through two thresholds, enabling adaptation across nutrient-poor, intermediate and nutrient-rich regimes. Simulations show that nutrient limitation produces a high and sustained proportion of persister cells even when biomass is reduced, whereas nutrient-rich conditions support reversion to proliferative growth and lead to greater biomass. The model also predicts that persister populations peak at times that vary with nutrient availability, and these peaks coincide with turning points in biofilm growth, identifying critical intervention windows. By directly linking nutrient availability to phenotypic switching, our model reveals mechanisms of biofilm persistence that earlier models could not capture, and it points toward strategies that target nutrient-driven adaptation as a means to improve the control of implant-associated infections.