Abstract
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. pneumonia 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.
 Peer Review History: 
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 Received file 
 
 Average Peer review marks at initial stage: 6.5/10
 Average Peer review marks at publication stage: 8.0/10
 Reviewer(s) detail:
 Name: Dr. Müjde Eryılmaz 
 Affiliation: Ankara University, Turkey
 E-mail: meryilmaz@ankara.edu.tr
 
 Name: Dr. Tamer Mohamed Ali El Habibi
 Affiliation: Suez Canal University, Egypt.
 E-mail: tamer_hassan@pharm.suez.edu.eg
 
 Name: Dr. Ali Alyahawi
 Affiliation: Depatment of Pharmacy, Al-Razi University, Yemen.
 E-mail: alyahawipharm@yahoo.com
 Comments of reviewer(s): 
 
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Highlights
: INTRODUCTION Biofilms have been found to be involved in a wide range of microbial infections in the body, by one estimate 80% of all infections[1]
The present study showed that the most effective antibiotics against biofilm producing Gram negative isolates was imipenem and for Gram positive isolates was vancomycin
In the current study, biofilm formation was observed among 112/227 (49.3%) isolates, Out of which, 48 (21.10%) were high, 64 (28.2%) were moderate and
Summary
: INTRODUCTION Biofilms have been found to be involved in a wide range of microbial infections in the body, by one estimate 80% of all infections[1]. Infectious processes in which biofilms are involved include common problems such as bacterial vaginosis, urinary tract infections, catheter infections, middle ear infections, and dental plaque formation[2], gingivitis and contact lenses[3], fatal processes such as endocarditis, and inflammation in cystic fibrosis, and permanent indwelling devices like joint prostheses, heart valves, and intervertebral disc[4,5,6]. Of nearly 40 percent of all healthcare related infections, urinary tract infections (UTIs) are the leading cause of infection.
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