A global systematic review and meta-analysis on correlation between biofilm producers and non-biofilm producers with antibiotic resistance in Uropathogenic Escherichiacoli.

Escherichia coli accounts for nearly 80% of community-acquired and 50% of hospital-acquired urinary tract infections (UTI). This study aimed to evaluate the correlation between biofilm producers and Non-biofilm producers with antibiotic resistance in Uropathogenic Escherichia coli (UPEC) isolated from patients with UTI globally. The search was conducted between 1st 2000 to 30th October 2021 in various databases (PubMed, Scopus, Web of sciences, and Google Scholar) with suitable MeSH terms, and text words. Then, after applying the appropriate inclusion and exclusion criteria on the studies for their selection, the data were analyzed by CMA software. Thirty-seven studies met the eligibility criteria to include. The pooled prevalence of ESBL and MDR isolates were reported 37.9%, and 65.8%, respectively. Biofilm formation varied between 13.3% and 99% all over the world. A total of 74.4% of all isolates were biofilm producers, out of which 28.6%, 35.2%, and 38.6% showed strong, moderate, and weak biofilm. The highest and lowest resistance was against Amoxicillin and Meropenem with the prevalence of 80.8%, and 13%, respectively. Fourteen out of 17(82.35%) studies reported a positive correlation between biofilm and antibiotic resistance. Findings showed high numbers of isolates were able to form biofilm, which is one of the factors of antibiotic resistance, and this has been confirmed by the positive significant correlation between biofilm formation and antibiotic resistance that has been reported by studies included. Therefore, due to the importance of biofilm in the etiology of UTI caused by UPEC, it should be prevented; consequently, bacterial resistance can be reduced and controlled.

Garousi M ，Monazami Tabar S ，Mirazi H ，Asgari P ，Sabeghi P ，Salehi A ，Khaledi A ，Ghenaat Pisheh Sanani M ，Mirzahosseini HK ... -  《-》

A systematic review and meta-analysis of antibiotic resistance patterns, and the correlation between biofilm formation with virulence factors in uropathogenic E. coli isolated from urinary tract infections.

Urinary tract infection (UTI) is caused by the invasion of the pathogen in the urinary system that can manifest as symptomatic or asymptomatic bacteriuria. This study was conducted to investigate antibiotic resistance patterns, and the correlation between biofilm formations with virulence factors in uropathogenic E. coli isolates retrieved from UTI. We searched Scopus and Google Scholar, PubMed, Web of sciences for studies published in the English language between 1st 2005 to 31st December 2019. The Mesh terms and text words included "biofilms", OR "biofilm formation", AND "antibiotic resistance", OR "drug-resistance", OR "antimicrobial drug resistance", AND "urinary tract infections", OR "UTI", AND "biofilm related-genes", AND "virulence factors" AND "correlation", AND "Uropathogenic Escherichia coli", OR "Uropathogenic E. coli" AND "prevalence" AND "Iran". Data analyzed using Comprehensive Meta-Analysis (CMA) software. The random-effects model was used to calculate the pooled prevalence with 95% confidence interval (CI). The combined rates of biofilm formation in Uropathogenic E. coli (UPEC) isolates were achieved as 84.6% (95% CI: 72.7-91.9). Also, 24.8%, 26.1% and 44.6% of UPEC isolates were able to create strong, moderate and weak biofilm, respectively. The highest pooled antibiotic resistance was against Ampicillin followed by Tetracycline with resistance rates of 74.6% and 64.9%, respectively. Accordingly, some studies reported that biofilm production was significantly associated with antibiotic resistance and virulence genes (p < 0.05). This study showed a high tendency among UPEC isolates to form biofilm (more than 84%), also, most studies included in the present review reported a significant correlation between biofilm formation with antibiotic resistance and virulence factors.

Zhao F ，Yang H ，Bi D ，Khaledi A ，Qiao M ... -  《-》

Correlation between antimicrobial resistance, biofilm formation, and virulence determinants in uropathogenic Escherichia coli from Egyptian hospital.

Uropathogenic Escherichia coli (UPEC) is the main etiological agent behind community-acquired and hospital-acquired urinary tract infections (UTIs), which are among the most prevalent human infections. The management of UPEC infections is becoming increasingly difficult owing to multi-drug resistance, biofilm formation, and the possession of an extensive virulence arsenal. This study aims to characterize UPEC isolates in Tanta, Egypt, with regard to their antimicrobial resistance, phylogenetic profile, biofilm formation, and virulence, as well as the potential associations among these factors. One hundred UPEC isolates were obtained from UTI patients in Tanta, Egypt. Antimicrobial susceptibility was assessed using the Kirby-Bauer method. Extended-spectrum β-lactamases (ESBLs) production was screened using the double disk synergy test and confirmed with PCR. Biofilm formation was evaluated using the microtiter-plate assay and microscopy-based techniques. The phylogenetic groups of the isolates were determined. The hemolytic activity, motility, siderophore production, and serum resistance of the isolates were also evaluated. The clonal relatedness of the isolates was assessed using ERIC-PCR. Isolates displayed elevated resistance to cephalosporins (90-43%), sulfamethoxazole-trimethoprim (63%), and ciprofloxacin (53%). Ninety percent of the isolates were multidrug-resistant (MDR)/ extensively drug-resistant (XDR) and 67% produced ESBLs. Notably, there was an inverse correlation between biofilm formation and antimicrobial resistance, and 31%, 29%, 32%, and 8% of the isolates were strong, moderate, weak, and non-biofilm producers, respectively. Beta-hemolysis, motility, siderophore production, and serum resistance were detected in 64%, 84%, 65%, and 11% of the isolates, respectively. Siderophore production was correlated to resistance to multiple antibiotics, while hemolysis was more prevalent in susceptible isolates and associated with stronger biofilms. Phylogroups B2 and D predominated, with lower resistance and stronger biofilms in group B2. ERIC-PCR revealed considerable diversity among the isolates. This research highlights the dissemination of resistance in UPEC in Tanta, Egypt. The evident correlation between biofilm and resistance suggests a resistance cost on bacterial cells; and that isolates with lower resistance may rely on biofilms to enhance their survival. This emphasizes the importance of considering biofilm formation ability during the treatment of UPEC infections to avoid therapeutic failure and/or infection recurrence.

Alshaikh SA ，El-Banna T ，Sonbol F ，Farghali MH ... -  《Annals of Clinical Microbiology and Antimicrobials》

Extended spectrum β-lactamase producing uropathogenic Escherichia coli and the correlation of biofilm with antibiotics resistance in Nepal.

Shrestha R ，Khanal S ，Poudel P ，Khadayat K ，Ghaju S ，Bhandari A ，Lekhak S ，Pant ND ，Sharma M ，Marasini BP ... -  《-》

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

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. 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. 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). 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.

Raya S ，Belbase A ，Dhakal L ，Govinda Prajapati K ，Baidya R ，Kishor Bimali N ... -  《-》