Biofilm formation and antimicrobial resistance of Enterobacteriaceae isolated from cancer patients with urinary tract infections

Introduction: The rise of multi-drug resistant (MDR) uropathogenic Enterobacteriaceae in cancer patients is of significant concern, and biofilm formation further increases the risk of MDR infections. This study was designed to determine the association between MDR and biofilm formation in coliforms isolated from cancer patients with urinary tract infections (UTIs).
Methods: The study was conducted over 50 consecutive days, using coliform isolates obtained from cancer patients with UTI. Bacteria were identified using routine biochemical tests. Antibiotic susceptibility data were obtained from laboratory records. Relevant clinical data of the patients were collected from inpatient clinical records (BHTs). Biofilm formation was assessed by performing tube method (TM) and tissue culture plate (TCP) method.
Results: A total of 67 coliform isolates were included in the study. The majority of the isolates were Escherichia coli followed by Klebsiella pneumoniae. 64.2% of the coliforms were MDR. Of the isolates, 62.7% and 67.2% were identified as biofilm formers according to the TM and TCP methods respectively. Biofilm formation was significantly higher in coliforms isolated from cancer patients with urinary catheters (20/24, 83.3%) and those with diabetes mellitus (28/36, 77.8%). Klebsiella sp. had a significantly high (p<0.05) ability (21/26, 80.8%) to form biofilms. Of the biofilm formers, 64.4 % (29/45) were identified as MDR bacteria.
Conclusion: E. coli and Klebsiella pneumoniae were the predominant uropathogens. A significant association between biofilm formation and multi-drug resistance was not demonstrated in this study (p>0.05). Urinary catheterisation, type of Enterobacteriaceae species and diabetes mellitus were significantly associated with biofilm formation (p<0.05).