Bacterial biofilm-based catheter-associated urinary tract infections: Causative pathogens and antibiotic resistance

doi:10.1016/j.ajic.2017.05.009

American Journal of Infection Control

Volume 45, Issue 10, 1 October 2017, Pages 1101-1105

https://doi.org/10.1016/j.ajic.2017.05.009 Get rights and content

Highlights

•
Biofilm based catheter associated urinary tract infection is now an emerging problem.
•
Biofilm production is greatly influenced by male gender, increased duration of catheterization and by use of latex catheter.
•
E.coli is the most common isolate of CAUTI but Enterobacter cloacae exhibit highest biofilm production.
•
High antibiotic resistance observe in biofilm producing strains due to slow penetration, resistant phenotype and altered micro environment.
•
Good infection control policies and antibiotic stewardship are needs of hour.

Background

We sought to determine the incidence of bacterial biofilm-based catheter-associated urinary tract infections, identify variables affecting biofilm formation, and identify etiologic bacterial pathogens and antibiotic-resistance patterns associated with biofilm-based catheter-associated urinary tract infections (CAUTIs) in our setup.

Methods

Patients who developed at least 2 symptoms of urinary tract infection after at least 2 days of indwelling urinary catheters were included. Urine was collected aseptically from catheter tubing and processed per standard microbiologic practices. Bacterial pathogens were identified on the basis of gram staining, colony morphology, and biochemical reactions. The detection of the biofilm was done using the tube adherence method. Drug susceptibility testing was done using the Kirby-Bauer disc diffusion method.

Findings

Biofilm was detected in 73.4% isolates, whereas 26.6% of isolates were nonbiofilm producers. Mean duration of catheterization after which biofilm was detected was 5.01 ± 1.31 days. A latex catheter was used in 69.5% of patients, whereas a silicone catheter was used in 30.4% of patients. Escherichia coli was found to be the most common pathogen isolated (52.3%), whereas Enterobacter cloacae exhibited the highest biofilm production (87.5%) among isolated pathogens. Among biofilm producers, the highest resistance was observed with ampicillin (100%). Fosfomycin exhibited the lowest resistance (17.2%). Significant association with biofilm was detected for gender, duration of catheterization, and type of catheter.

Conclusion

Biofilm-based CAUTI is an emerging problem. E coli was the most frequent isolate. High antibiotic resistance was observed in biofilm-producing strains. Using the variables affecting biofilm formation, tailored intervention strategies can be implemented to reduce biofilm-based CAUTIs.

Section snippets

Material and methods

This was a cross-sectional study conducted at the Department of Microbiology, Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan, July 2015-January 2017. A total of 1,070 urine specimens from 8 different departments of tertiary care hospitals of northern Pakistan were included in the study. CAUTI was defined using a combination of clinical signs and symptoms and laboratory criteria (Table 1).

All catheterized patients irrespective of gender and age

Results

A total of 1,070 urine samples from CAUTI patients were analyzed. Among study subjects there were 840 (78.5%) men and 230 (21.49%) women. The overall mean age of study subjects was 52.78 ± 13.36 years. Most patients were from urology departments (n = 510 [47.6%]) followed by surgical wards (n = 140 [13.1%]), gynecology wards (n = 100 [9.3%]), medical wards (n = 90 [8.4%]), outpatient departments (n = 95 [8.9%]), neurology departments (n = 65 [6.1%]), rehabilitation (n = 45 [4.2%]), and

Discussion

UTI attributed to use of an indwelling urinary catheter is among the most common HAIs. Because biofilms ultimately develop on these devices, the major variables that influence biofilm formation need to be determined. Our study determined the effect of various variables on biofilm formation exclusively in patients with CAUTI.

In our study, the frequency of CAUTI was greater in men compared with women: 78.5% of patients were men and 21.5% of patients were women. Similar results were shown by Kazi

Conclusions

Biofilm plays a key role in pathogenesis of CAUTI. Biofilm-based CAUTI is an emerging problem. Biofilm formation is greatly influenced by duration of catheterization and type of catheter. Using the variables affecting biofilm formation, tailored intervention strategies can be implemented to reduce these infections. Escherichia coli is the most commonly isolated pathogen of CAUTI. Enterobacter cloacae has the highest potential to form biofilm. Biofilm greatly enhances antibiotic resistance.

Acknowledgments

The authors thank Mrs Bushra Sabir, senior lecturer at Bahria University Islamabad, for providing statistical analysis.

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: Supported by Armed Forces Institute of Pathology, Rawalpindi Pakistan.

: Conflicts of interest: None to report.

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Major ArticleBacterial biofilm-based catheter-associated urinary tract infections: Causative pathogens and antibiotic resistance

Highlights

Background

Methods

Findings

Conclusion

Section snippets

Material and methods

Results

Discussion

Conclusions

Acknowledgments

Asian Pac J Trop Med

Am J Infect Control

Am J Med

Antibacterial effects of tungsten nanoparticles on the Escheria coli strains isolated from catheterized urinary tract infections (UTI) cases and Staphlococcus aureus

New Microbiol

Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention

Am J Med

A decade of prevalence surveys in a tertiary care center: trends in nosocomial infection rates, device utilization and patient acuity

Infect Control Hosp Epidemiol

Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: a systematic review and meta-analysis

Ann Intern Med

Catheter-associated urinary tract infections and antibiotic sensitivity pattern from confirmed cases of CAUTI in a tertiary care hospital: a prospective study

J Clin Microbiol

The isolation and biofilm formation of uropathogens in the patients with catheter associated urinary tract infections (CAUTI)

J Clin Diagn Res

Biofilm formation by clinical isolates and its relevance to clinical infections. Biofilm based health-care associated infections. Volume 830 of the series

Adv Exp Med Biol

Clinical and microbiological aspects of biofilm associated surgical site infections

Adv Exp Med Biol

A biofilm, a city of microbes

J Bacteriol

Biofilm formation; a clinically relevant microbiological process

Clin Infect Dis

The epidemiology of the intensive care unit acquired urinary tract infections

Curr Opin Infect Dis

Major Article
Bacterial biofilm-based catheter-associated urinary tract infections: Causative pathogens and antibiotic resistance