Outer membrane vesicle (OMV) serves as a crucial carrier in bacterial communication and drug resistance transmission. This review summarizes the formation mechanisms and compositional characteristics of OMV regulated by outer membrane cross-linking, lipids, and signaling molecules. It focuses on the diverse mechanisms by which OMV mediate drug resistance, including horizontal transfer and expression regulation of resistance genes, enhanced efflux capabilities, involvement in biofilm formation, and modulation of host immune responses. Finally, it explores the research direction of OMV as novel anti-infection target, aiming to provide a theoretical basis for overcoming bacterial resistance challenges and developing new therapeutic strategies.