A Study on Phenotypic Association between Biofilm and Drug Resistant Klebsiella Species Isolated from Urinary Tract Infections

Abstract

Introduction: Urinary Tract Infections (UTI's) are considered to be one of the most prominent infections, worldwide. Klebsiella species are the commonest cause of community and hospital acquired UTIs. Biofilm production and hyper-mucous production are the important virulence factors among the pathogenic strains of Klebsiella species. Biofilm-associated and Hyper-Mucoviscosity (HMV) variants of Kiebsiella spp. ispotent enough to easily colonise the urinary tract, develop the invasiveness of infection and mainly contribute in higherresistance to most classes of antibiotics. Understanding the virulence factors associated with Multi Drug Resistant (MDR) Klebsiella spp. would aid in estimating the resistance related mortality. Aim: To identify and comparatively analyse the HMV, biofilm-producing capacity and drug resistance pattern of archived Klebsiella spp. isolates from UTI. Materials and Methods: This study was a cross-sectional, descriptive study. A retrospective analysis was performed during January 2020 to March 2020 on 207 archived Klebsiellaspp. isolates collected between December 2017 to January 2019. The presumptive identification of Klebsiella spp. was done using standard microbiological techniques. Antimicrobial susceptibility test was performed as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Klebsiella spp. were tested for biofilm production using microtiter plate method and HMV phenotype by string test. Descriptive statistics and Student’s t-test were performed to analyse the data. Results: A total of 207 Klebsiella isolates were used in this study and majority (94.6%) of the isolates were identified as Klebsiella pneumoniae subsp. pneumoniae. Out of 207 isolates, 14 isolates (6.8%) were Extensively Drug Resistant (XDR); 141 isolates (68.1%) were MDR; 43 isolates (20.8%) were resistant to one or two class of antibiotics. Biofilm detection assay showed 97.1% (201/207) were strong biofilm producers and 2.9% (6/207) were moderate biofilm producers. String test for HMV detection showed only two isolates (1.0%) were positive HMV producers. Among the biofilm producers, majority of the Klebsiella isolates were found to be MDR. Conclusion: Resistance in Klebsiella spp. is an evolving problem. Majority of the drug resistant Klebsiella isolates used in present study were strong biofilm producers. This study emphasises on the sensible use of last resort drugs to cut down the evolution of resistant strains.