Biofilm Formation in UPEC Isolates and its Association with Extended-Spectrum β-Lactamase Production and MDR in Hospitalized Patients: Gurugram, India

Abstract

Urinary tract infections (UTI) are perhaps the most regular issues in hospitalized patients. Gram negative bacteria which produces Biofilm and Extended-range ß-lactamases (ESBL) have become the serious issue in the medical clinics across the globe. Increase in biofilm & ESBL forming organisms in recent years has led to the limitation of treatment option. This study was done to evaluate the Biofilm production in uropathogenic E. coli (UPEC) and its association with ESBL, its antibiogram and Multi-drug resistance (MDR) status in hospitalized patients. 885 urine samples (non-repetitive) were collected in the study. A total of 106 (11.98%) UPEC strains were isolated. Females were found to be more infected as compare to males. The most affected age group was >46 years. 73.58% of the UPEC isolates were Biofilm producer (BFP). MDR was found in 84.91% strains (Biofilm +VE: 97.44 %; Biofilm -VE" 50.0%). Tissue culture plate (TCP) method was most sensitive test method for the detection of biofilms. The most sensitive drug in BFP's were Imipenem (82.0%), Ertapenem (81.0%), Nitrofurantoin (72.0%) and Amikacin (69.0%) and Nitrofurantoin, Imipenem (100.0% each), Amikacin (96.0%) and Ertapenem, Piperacillin/Tazobactam (93.0% each) in Biofilm non producers. The ability of biofilm production was found significantly higher in ESBL positive UPEC strains. An association was found between biofilm production and antibiotic resistance. Therefore, the UTIs caused by BFP's E.coli may promote the colonization and increased the incidence rate of UTIs. It was found that biofilm makes the organism more resistant to the antibiotics and virulent as compare to non-biofilm producers (NBFP's). The UPEC employ their biofilm forming abilities to invade and successfully occupy tissues in the urogenital tract.