Propensity for biofilm formation by clinical isolates from urinary tract infections: developing a multifactorial predictive model to improve antibiotherapy

J Med Microbiol. 2014 Mar;63(Pt 3):471-477. doi: 10.1099/jmm.0.071746-0. Epub 2014 Jan 15.

Abstract

A group of biofilm-producing bacteria isolated from patients with urinary tract infections was evaluated, identifying the main factors contributing to biofilm formation. Among the 156 isolates, 58 (37.2%) were biofilm producers. The bacterial species (P<0.001), together with patient's gender (P = 0.022), were the factors with the highest influence for biofilm production. There was also a strong correlation of catheterization with biofilm formation, despite being less significant (P = 0.070) than species or gender. In fact, some of the bacteria isolated were biofilm producers in all cases. With regard to resistance profile among bacterial isolates, β-lactam antibiotics presented the highest number of cases/percentages--ampicillin (32/55.2%), cephalothin (30/51.7%), amoxicillin/clavulanic acid (22/37.9%)--although the carbapenem group still represented a good therapeutic option (2/3.4%). Quinolones (nucleic acid synthesis inhibitors) also showed high resistance percentages. Furthermore, biofilm production clearly increases bacterial resistance. Almost half of the biofilm-producing bacteria showed resistance against at least three different groups of antibiotics. Bacterial resistance is often associated with catheterization. Accordingly, intrinsic (age and gender) and extrinsic (hospital unit, bacterial isolate and catheterization) factors were used to build a predictive model, by evaluating the contribution of each factor to biofilm production. In this way, it is possible to anticipate biofilm occurrence immediately after bacterial identification, allowing selection of a more effective antibiotic (among the susceptibility options suggested by the antibiogram) against biofilm-producing bacteria. This approach reduces the putative bacterial resistance during treatment, and the consequent need to adjust antibiotherapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acinetobacter Infections / microbiology*
  • Acinetobacter baumannii / drug effects
  • Acinetobacter baumannii / physiology
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / pharmacology*
  • Biofilms / growth & development*
  • Child
  • Child, Preschool
  • Enterobacteriaceae / drug effects
  • Enterobacteriaceae / physiology
  • Enterobacteriaceae Infections / microbiology*
  • Female
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Models, Biological
  • Pseudomonas Infections / microbiology*
  • Pseudomonas aeruginosa / drug effects
  • Pseudomonas aeruginosa / physiology
  • Retrospective Studies
  • Urinary Catheterization / adverse effects
  • Urinary Tract Infections / microbiology*
  • Young Adult

Substances

  • Anti-Bacterial Agents