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Background  Nosocomial infections and persistence of multidrug resistant biofilm forming  Acinetobacter baumannii  in hospitals has made it as a serious problem in healthcare settings worldwide.    Methods  A total of 100  A. baumannii  clinical isolates from immunocompromised patients hospitalized in ICU were investigated for biofilm formation, the presence of biofilm related genes ( bap, ompA, csuE, fimH, epsA, bla   PER-1   , bfmS, ptk, pgaB, csgA, kpsMII ), integron characterization and molecular typing based on REP-PCR.    Results  All isolates were resistant to three or more categories of antibiotics and considered as multidrug resistant (MDR). A total of 32 isolates were resistant to all tested antibiotics and 91% were extensively drug-resistance (XDR). All isolates were able to produce biofilm and 58% of isolates showed strong ability to biofilm formation. All strong biofilm forming  A. baumannii  isolates were XDR. All  A. baumannii  isolates carried at least one biofilm related gene. The most prevalent gene was  csuE  (100%), followed by  pgaB  (98%),  epsA  and  ptk  (95%),  bfmS  (92%) and  ompA  (81%). 98% of isolates carried more than 4 biofilm related genes, simultaneously. Class I integron (67%) was more frequent in comparison with class II (10%) ( P  < 0.05). The REP-PCR patterns were classified as 8 types (A-H) and 21 subtypes. The A1 (23%) and C1 (15%) clusters were the most prevalent among  A. baumannii  isolates ( P  < 0.05). According to the REP-PCR patterns, 23% of all isolates had a clonal relatedness.    Conclusion  Our study revealed the high frequency of biofilm forming XDR  A. baumannii  in ICU patients, with a high prevalence of biofilm related genes of  csuE  and  pgaB.  It seems that the appropriate surveillance and control measures are essential to prevent the emergence and transmission of XDR  A. baumannii  in our country.

Virulence characteristics of multidrug resistant biofilm forming Acinetobacter baumannii isolated from intensive care unit patients