Magnitude of Biofilm Formation and Antimicrobial Resistance Pattern of Bacteria Isolated from Urinary Catheterized Inpatients of Jimma University Medical Center, Southwest Ethiopia

Hindawi International Journal of Microbiology Volume 2019, Article ID 5729568, 9 pages https://doi.org/10.1155/2019/5729568 Research Article Magnitude of Biofilm Formation and Antimicrobial Resistance Pattern of Bacteria Isolated from Urinary Catheterized Inpatients of Jimma University Medical Center, Southwest Ethiopia Netsanet Awoke ,1 Tesfaye Kassa ,2 and Lule Teshager3 1 Department of Medical Laboratory Science, Dilla University, Dilla, Ethiopia School of Medical Laboratory Science, Jimma University, P.O. Box 378, Jimma, Ethiopia 3 School of Medical Laboratory Science, Jimma University, P.O. Box 788, Jimma, Ethiopia 2 Correspondence should be addressed to Tesfaye Kassa; Received 8 September 2018; Revised 21 December 2018; Accepted 20 January 2019; Published 10 February 2019 Academic Editor: Joseph Falkinham Copyright © 2019 Netsanet Awoke 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. Biofilm formation is one of the features of most bacteria. Catheterization in medicine is a source of highly resistant bacterial infections, and those bacteria respond poorly to antimicrobial therapy. Bacterial biofilm features were not described from catheterized inpatients in Ethiopia as its formation is known to afford antimicrobial resistance and challenge patient management. The aim of this study was to isolate catheter-associated urinary bacterial pathogens, their biofilm formation, and antimicrobial susceptibility pattern among inpatients of Jimma University Medical Center (JUMC) in Southwest Ethiopia. A prospective crosssectional study was conducted among urinary catheterized inpatients of JUMC from February to August 2016. A total of 143 study participants were enrolled consecutively in this study. Urine samples were collected from catheterized patients and processed using a standard bacteriological protocol for isolation and identification. Evaluation of in vitro biofilm formation and antimicrobial susceptibility pattern of uropathogenic bacteria was done using microtiter plates and disk diffusion method, respectively. Data were cleaned, coded, and entered into SPSS version 20 for analysis. All statistical test values of p < 0.05 were considered statistically significant. From all study participants, mean age was 44 years. Sixty bacterial strains were recovered from 57 urinary catheterized inpatients among which 54 of them were monomicrobial (94.7%). The remaining six bacterial strains were recovered from three study participants each with two bacterial isolates. The predominant bacterial isolates were Gram-negative bacteria with E. coli turning out first. About 80% of bacterial isolates were biofilm formers. The majority of the bacteria were resistant to commonly prescribed antimicrobial agents. In conclusion, the majority of bacterial uropathogen isolates were Gramnegative, biofilm formers, and resistant to commonly prescribed antimicrobial agents. Relatively ciprofloxacin, nitrofurantoin, and amikacin were highly effective against most isolated bacteria. 1. Introduction Urinary tract infections (UTIs) account up to 40% of all hospital acquired infections around the globe, and more than 80% of nosocomial UTIs are usually associated with catheterization [1–3]. High prevalence of catheterization in a hospital setup leads to a large cumulative burden of catheterassociated UTIs with the resultant rise in morbidity and mortality [4]. The common uropathogenic bacteria known are Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus spp., and some other Gram-negative and Gram-positive bacteria [5, 6]. On the contrary, the emergence and spread of antimicrobial resistance among members of the family Enterobacteriaceae, particularly E. coli and Klebsiella species, are very common [7–10]. The high magnitude of antimicrobial resistance among 2 catheter-associated UTIs has important economic implications particularly in developing countries where resources are lacking [3, 10]. Bacterial biofilm is a complex community of microorganisms with production of extracellular polysaccharide matrix on damaged tissue and surface of indwelling medical devices including urinary catheter. Despite catheter is generally critical indwelling medical device and indispensable in medicine, its prolonged use in hospitalized patients expose them to infection. This process allows bacteria to enter to the bladder and form biofilm either through migrating along the intra- or extraluminal parts of the catheter surface [11, 12]. This bacterial feature of biofilm production is very important in contributing to catheter-associated UTIs in hospital setting. Bacterial biofilm development, on the other hand, is highly associated with the bacteria to afford inherent antimicrobial resistance such as the host’s defense mechanisms and exogenous antimicrobial agents. This resistance makes the bacteria to be a major challenge for patient recovery [11]. It has been determined that biofilm-forming bacteria have shown resistance to antimicrobials as much as 1000 times more than their planktonic counterparts [1, 13]. Chronic and complicated UTIs can result in discomfort to the patient and prolonged hospital stay. This in turn ultimately increases hospital burdens, health care costs for diagnosis and treatment as well as higher morbidity and mortality of patients [1, 14–16]. The magnitude of catheter-associated UTIs problems remains underestimated largely in developing countries, whereas it is a persistently common problem [17, 18]. This is because of inadequate surveillance and absence of regular reporting system to national level. Its diagnosis and surveillance activities to guide preventions and interventions require expertise, facilities, and other resources [19]. On the other hand, detection of biofilm development of microorganisms in medicine has been progressing very slowly. This may be for the fact that overall knowledge about microorganisms living in biofilm communities is less among health professionals. This may be the perception that bacteria are single-celled organisms living an individual lifestyle [20]. For this reason, biofilm-related researches are important to bring front for the health professional attentiveness and future study initiation in Ethiopia. Although community-acquired UTIs have been investigated in different groups of patients in Ethiopia, only very few studies have investigated and documented on the etiological agents of catheter-associated UTIs and their susceptibility pattern to antimicrobial agents [21, 22]. The updated pattern of antimicrobial susceptibility report helps in proper patient management as there were reports of variability in time and space. Moreover, there was no study on biofilm profiles of uropathogenic bacteria from catheterized patients in this study location in Jimma. Therefore, the aim of this study (...truncated)