Abstract
Biofilm formation of multidrug and extensively drug resistant Klebsiella pneumoniae isolates is poorly understood. We investigated 139 diverse clinical K. pneumoniae isolates that possess various resistance patterns to evaluate the relationship between biofilm formation and resistance. Antimicrobial resistance was compared among a diverse collection of weak versus strong biofilm-forming K. pneumoniae, and predictors of strong biofilm formation were identified. Multi-drug resistant isolates were more common among weak (97.9%) versus strong biofilm formers (76%; P = 0.002). Carbapenem-resistant K. pneumoniae were 91% less likely to form strong biofilm (odds ratio 0.09; 95% confidence interval 0.02–0.33). The statistically significant inverse relationship between biofilm formation and antibiotic resistance suggests that virulence may be a trade-off for survival.
Highlights
Klebsiella pneumoniae, the most common and most concerning carbapenem-resistantEnterobacteriaceae (CRE) [1], is associated with mortality rates up to 50% [2]
MATERIALS AND METHODS: Our study included 139 unique K. pneumoniae clinical isolates obtained from the Centers for Disease Control and Prevention (CDC; n=66), Biodefense and Emerging Infections (BEI; n=36), American Type Culture Collection (ATCC; n=3), and Providence Veterans Affairs (VA) Medical
The only predictor of biofilm formation was carbapenem resistance, which was inversely associated with strong biofilm formation
Summary
Klebsiella pneumoniae, the most common and most concerning carbapenem-resistant. Enterobacteriaceae (CRE) [1], is associated with mortality rates up to 50% [2]. Adding to this challenging infection is K. pneumoniae’s high propensity to form biofilms [3, 4]. K. pneumoniae are associated with foreign indwelling device related infections [4], as well as urinary stones [5,6,7]. The most common K. pneumoniae infections include urinary tract infections, pneumonia, as well as intra-abdominal infections, which are prone to biofilm formation[4, 8]. Clinical microbiology labs cannot routinely test for biofilm formation; tested phenotypic characteristics may help clinicians predict biofilm potential
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