BIOFILM FORMATION AND ANTIBIOTIC SUSCEPTIBILITY OF UROPATHOGENS IN PATIENTS WITH CATHETER ASSOCIATED URINARY TRACT INFECTIONS IN IBB CITY -YEMEN

Biofilm formation by uropathogens on the surface of indwelling medical devices can inflict obstinate or recurring infection, thought-provoking antimicrobial therapy. This study included 227 patients with indwelling urinary catheters and suffering from CAUTI. They were analyzed for biofilm formation and antibiogram susceptibility, 59.4% were males and 40.6% were females. Ensuing phenotypic identification of isolated bacteria, antibiotic sensitivity test was performed by modified Kirby–Bauer disc diffusion method following the Clinical and Laboratory Standards Institute (CLSI 2015) guidelines; Biofilm-forming uropathogens were detected by the tissue culture plate (TCA) method. The predominant uropathogen in catheter-associated UTIs (CAUTIs) was Escherichia coli 46.3%, followed by K. pneumoniae 18.5%, P. aeruginosa 11.9%, 7%, S. coagulase negative 5.7%, S. aureus 4.8%, Enterobacter spp. 4.4%, E. faecalis 1.3%. The total rate of biofilm producer bacteria was 49.3% (21.1% high producers, 28.2% moderate producers). Prime biofilm producers were E. coli 60% with OR=8.6 (p=0.002), followed by K. pneumoniae 57.1% with OR=10.1 (p=0.002), and P. aeruginosa 37% with OR=6.6 (p=0.02). The biofilm producers bacteria were associated with >65year patients (OR=5.4, p>0.001), pre-UTI (OR=2.4, p<0.001), long duration of catheterization (OR=15.3, p<0.001), and diabetic mellitus (OR=3.5, p<0.001). Multidrug resistance associated with biofilm producers were greater than biofilm non-producers. Gram-negative biofilm producers found 100%, 100%, 88.6%, 82.9%, 81.9%, 80.9%, and 72.4%, 40%, 33% resistant to ampicillin , amoxyclave, cotrimoxazole, ceftraxone, nalidixic acid, ciprofloxacin, cefotaxime , nitrofurantoin and amikacin respectively. Gram-positive biofilm producers, however, were found 85.7%, 85.7%, 71.4%, 71.4%, 57.1% and 42.9% resistant to penicillin, erythromycin, cotrimoxazole, gentamycin, norfloxacin, and nitrofurantoin respectively. In conclusion, a high antimicrobial resistance was observed in biofilm producers than non-biofilm producers. Of recommended antimicrobial therapies for CAUTIs, ampicillin and amoxicillin-clavulanate were the least active antibiotics, whereas imipenem and amikacin were found as the most effectual for gram-negative biofilm producer. Likewise, penicillin and erythromycin were the least active antibiotics, whereas vancomycin, and rifampicin were found as the most effective antibiotic for Gram-positive biofilm producer.