Catheter-Associated Urinary Tract Infection and Obstinate Biofilm Producers

Hindawi Canadian Journal of Infectious Diseases and Medical Microbiology Volume 2018, Article ID 7624857, 7 pages https://doi.org/10.1155/2018/7624857 Research Article Catheter-Associated Urinary Tract Infection and Obstinate Biofilm Producers Govinda Maharjan,1 Priyatam Khadka ,2 Gomik Siddhi Shilpakar,1 Ganesh Chapagain,3 and Guna Raj Dhungana1 1 Janamaitri Foundation Institute of Health Science (JFIHS), Kathmandu, Nepal Department of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal 3 Department of Pathology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal 2 Correspondence should be addressed to Priyatam Khadka; Received 23 May 2018; Accepted 29 July 2018; Published 26 August 2018 Academic Editor: Leticia Reyes Copyright © 2018 Govinda Maharjan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Biofilms, or colonies of uropathogen growing on the surface of indwelling medical devices, can inflict obstinate or recurring infection, thought-provoking antimicrobial therapy. Methods. This prospective analysis included 105 urine samples from catheterized patients receiving intensive care. Ensuing phenotypic identification, antibiotic sensitivity test was performed by modified Kirby–Bauer disc diffusion method following CLSI guidelines; MDR isolates were identified according to the combined guidelines of the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC). Biofilm-forming uropathogens were detected by the tissue culture plate (TCA) method. Results. The predominant uropathogen in catheter-associated UTIs (CAUTIs) was Escherichia coli 57%, followed by Klebsiella pneumonia 15%, Pseudomonas aeruginosa 12%, Staphylococcus aureus 8%, Enterobacter spp. 3%, Enterococcus faecalis, Acinetobacter spp., and Proteus mirabilis 1.5%, of which 46% isolates were biofilm producers. Prime biofilm producers were Escherichia coli 33%, followed by Klebsiella pneumoniae 30%, Pseudomonas aeruginosa 20%, Staphylococcus aureus 10%, Acinetobacter, and Enterobacter 3.33%. Multidrug resistance associated with biofilm producers were greater than biofilm nonproducers. The Gram-negative biofilm producers found 96.15%, 80.76%, 73.07%, 53.84%, 53.84%, 46.15%, 19.23%, and 11.5% resistant to amoxyclave, ceftazidime, tetracycline, gentamicin, meropenem, nitrofurantoin, amikacin, imipenem, and fosfomycin, respectively. Gram-positive biofilm producers, however, were found 100% resistant to tetracycline, cloxacillin, and amoxyclave: 66.67% resistant to ampicillin while 33.33% resistant to gentamicin, ciprofloxacin, and nitrofurantoin. Conclusion. High antimicrobial resistance was observed in biofilm producers than non-biofilm producers. Of recommended antimicrobial therapies for CAUTIs, ampicillin and amoxicillinclavulanate were the least active antibiotics, whereas piperacillin/tazobactam and imipenem were found as the most effectual for gram-negative biofilm producer. Likewise, amoxicillin-clavulanate and tetracycline were the least active antibiotics, whereas vancomycin, fosfomycin, piperacillin-tazobactam, and meropenem were found as the most effective antibiotic for Gram-positive biofilm producer. In the limelight, the activity fosfomycin was commendable against both Gram-positive and Gram-negative biofilm producers. 1. Background Of nearly 40 percentile of all health care-associated infections, urinary tract infections (UTIs) are the foremost cause of infections; out of these, a bulky proportion, 80%, involve catheter-associated urinary tract infections (CAUTIs) [1]. The urinary catheters are routinely used in urology practice; albeit, advances in design and materials used, UTIs persist as the major snags, owing to the contamination of such indwelling devices [2]. Approximately, prior admission, 12 to 16% of adult hospital inpatients have an indwelling urinary catheter, however, known to be associated with high morbidity, high mortality, increased the length of hospital stay, and increased the cost of treatment [1–3]. 2 Canadian Journal of Infectious Diseases and Medical Microbiology Furthermore, the catheter-associated biofilm producers, preceding drug resistivity, and their thought-provoking infection control procedures have been reported in aforementioned studies, which raises our concern on CAUTIs and biofilm producers in our settings [4, 5]. Biofilms are the sessile polymicrobial communities attached to the substratum of biotic and abiotic surfaces and are sheathed within a self-produced extracellular polymeric matrix, that is, polysaccharides intercellular adhesin [2, 5, 6]. The extracellular matrix facilitates communications among the cells through biochemical signals—acyl-homoserine lactone in Gram-negative bacteria and oligopeptides in Gram-positive bacteria—in a phenomenon called as quorum sensing [7]. Not only the matrix precludes the pathogen against host defense but also attributes antimicrobial resistance, by subordinating antibiotic penetration, horizontal transmission of plasmid-associated drug-resistant gene, and altered microenvironment [6, 7]. In this standpoint, early detection of biofilm producers is crucial, to reduce the irrational antimicrobial burden proceeding antimicrobial resistance in the patient; hence, it would be an auxiliary in controlling device-associated infections in medical centers.” The rationale of our study was to explicate bacterial etiologies, illuminate biofilm-associated resistivity patterns, and to endorse suitable antimicrobial therapy against biofilm producers in CAUTIs. 2. Material and Methods 2.1. Study Design and Setup. The cross-sectional study was conducted at the Department of Microbiology, Janamaitri Foundation Institute of Health Science (JFIHS), Nepal, over a period of six months. The study hospital is a referral centre with medical, surgical, gynecological, pediatric, geriatric, and other specialties. 2.2. Inclusion and Exclusion Criteria. The urine sample of all catheterized patients irrespective of gender and age between 12 and 70 years who met the criteria of CAUTI were included in the study. Nevertheless, noncatheterized patients, either nursed in ward or formerly under antimicrobial therapy at least 48 h prior catheter insertion and no more than two types of organism grown from the clinical sample, were considered as contaminated and consequently, excluded from the study. 2.3. Laboratory Methods. CAUTI was defined using a combination of clinical signs and symptoms and laboratory criteria as described by Stamm [2]. A total of 105 urine sample from the catheterized patient, admitted in intensive care units, were processed semiquantitatively by inoculating 0.001 ml of the specimen (by using a calibrated wire loop) onto the Cystine Lactose Electrolyte Deficient (CLED) agar for the isolation (...truncated)