In-Vitro Biofilm Formation and Antimicrobial Resistance of Escherichia coli in Diabetic and Nondiabetic Patients

Abstract

Background. Diabetic patients are more susceptible to urinary tract infection compared to nondiabetic patients, Escherichia coli being the most common uropathogen causing UTI. Unreasonable and incorrect antibiotic prescription for UTI in these patients may induce the development of antibiotic-resistant urinary pathogens resulting in delayed recovery and longer hospitalization. In addition to these, biofilm forming capacity of the pathogen may worsen the problem. The main aim of this cross-sectional study (conducted from March to September 2015) is to detect the biofilm forming capacity of UTI causing micro-organisms and compare the antibiotic resistance pattern of Escherichia coli, the most common cause of UTI, which will help the physician in choosing the best antibiotic. Method. Total of 1,099 clean-catch mid stream urine (CCMSU) was processed by standard microbiological technique; 182 were from the diabetic group and 917 nondiabetic. Following identification, all isolates were subjected to antibiotic susceptibility testing using modified Kirby-Bauer disc diffusion method. In-vitro biofilm forming capacity of the isolates were detected by Microtitre plate method. The data were analyzed using SPSS software 16. Result. Urinary tract infection was found to be significantly higher in diabetic patients (42.9%) compared to nondiabetic patients (17.4%) with Escherichia coli as the most common uropathogen in both diabetic and nondiabetic groups. Similarly, UTI was more common in elderly population (29.5%). Imipenem, nitrofurantoin and amikacin were found to be the most effective drug for uropathogenic E. coli in both diabetic and nondiabetic patients, whereas amoxicillin, ciprofloxacin, and cotrimoxazole were least effective. Of the total bacterial isolates, 43.3% showed positive results for in-vitro biofilm production by the Microtitre plate method. A significantly higher resistance rate was observed among biofilm producing E. coli for quinolones, cotrimoxazole, and third generation cephalosporin ceftriaxone. Most of the biofilm producers (79.5%) were found to be MDR (p-value 0.015). Conclusion. Elderly populations with diabetes are at a higher risk of UTI. Higher biofilm production and resistance to in-use antimicrobial agents in this study render its inefficacy for empirical treatment and point out the importance of biofilm screening to ensure the effective management of infection.

Evaluating the antibiotic resistance and frequency of adhesion markers among Escherichia coli isolated from type 2 diabetes patients with urinary tract infection and its association with common polymorphism of mannose-binding lectin gene

“…Escherichia coli showed a high level of resistance to amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole and nalidixic acid. This result is consistent with the results of a study conducted in Nepal in 2019 [ 29 ]. In studies on E. coli , which causes UTI in Iran, the highest resistance is related to ampicillin, amoxicillin and tetracycline.…”

Detection of Biofilm Formation by Escherichia coli and Staphylococcus aureus Associated with Canine Pyometra

“…Similar conclusions were drawn by Golia et al (2012), who studied the correlation between biofilm formation of uropathogenic E. coli and antibiotic resistance pattern and documented that biofilm producing isolates exhabited high degree of resistance towards broad spectrum antibiotics. Raya et al (2019) analysed in vitro biofilm formation and antimicrobial resistance of E. coli in diabetic and non-diabetic patients and found that resistance was higher in biofilm producing E. coli compared to nonbiofilm isolates. Risal et al (2018) reported similar conclusions.…”

Association between biofilm-production and antibiotic resistance in Escherichia coli isolates: A laboratory-based case study and a literature review

“…In a similar study to ours, involving n 5 208 UPEC strains, Neupane et al concluded that ESBL-positive strains were more common among biofilm-producers [37]. In a Nepalese study by Raya et al, over a thousand cleancatch urine samples were processed from 182 diabetic and 917 non-diabetic patients, respectively: UTIs were more common among diabetic patients (17.4% vs. 42.9%); in addition, biofilm-production was more commonly seen in association with SXT, 3GCs and CIP resistance, and the MDR phenotype [38]. Whelan et al have also assessed the possible predictive power of colony morphology in relation to biofilm-formation in E. coli; however, in their setting, colony presentation on Cysteine Lactose Electrolyte Deficient (CLED) agar had a very low (4%) predictive power, when n 5 50 strong biofilm-producing strains were assessed [39].…”