 Gram-negative biofilm forming medical device associated pathogens such as Pseudomonas aeroginosa and Escherichia coli use a series of steps including adhesion, cellular aggregation and the production of an extracellular polymeric matrix to form biofilms. The biosynthesis and role of pylite and flagella in gram-negative adhesion and accumulation on surfaces are explored, as well as the process of biofilm maturation and the importance of quorum sensing systems in enabling gram-negative bacteria to adapt to their environments. The majority of gram-negative biofilms consist of polysaccharides of a simple sugar structure that provide an optimum environment for bacterial survival and maturation leading to increased resistance to antibiotics and predation. This article was authored by Gary Laverde, Sean P. Gorman and Brendan F. Gilmore. We are article.tv, links in the description below.