1
|
Mishra SK, Baidya S, Bhattarai A, Shrestha S, Homagain S, Rayamajhee B, Hui A, Willcox M. Bacteriology of endotracheal tube biofilms and antibiotic resistance: a systematic review. J Hosp Infect 2024; 147:146-157. [PMID: 38522561 DOI: 10.1016/j.jhin.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
Bacteria commonly adhere to surfaces and produce polymeric material to encase the attached cells to form communities called biofilms. Within these biofilms, bacteria can appear to be many times more resistant to antibiotics or disinfectants. This systematic review explores the prevalence and microbial profile associated with biofilm production of bacteria isolated from endotracheal tubes and its associations with antimicrobial resistance. A comprehensive search was performed on databases PubMed, Embase, and Google Scholar for relevant articles published between 1st January 2000 and 31st December 2022. The relevant articles were exported to Mendeley Desktop 1.19.8 and screened by title and abstract, followed by full text screening based on the eligibility criteria of the study. Quality assessment of the studies was performed using the Newcastle-Ottawa Scale (NOS) customized for cross-sectional studies. Furthermore, the prevalence of antimicrobial resistance in biofilm-producers isolated from endotracheal tube specimens was investigated. Twenty studies encompassing 981 endotracheal tubes met the eligibility criteria. Pseudomonas spp. and Acinetobacter spp. were predominant isolates among the biofilm producers. These biofilms provided strong resistance against commonly used antibiotics. The highest resistance rate observed in Pseudomonas spp. was against fluoroquinolones whereas the least resistance was seen against piperacillin-tazobactam. A similar trend of susceptibility was observed in Acinetobacter spp. with a very high resistance rate against fluoroquinolones, third-generation cephalosporins and carbapenems. In conclusion, endotracheal tubes were associated with colonization by biofilm forming bacteria with varying levels of antimicrobial resistance. Biofilms may promote the occurrence of recalcitrant infections in endotracheal tubes which need to be managed with appropriate protocols and antimicrobial stewardship. Research focus should shift towards meticulous exploration of biofilm-associated infections to improve detection and management.
Collapse
Affiliation(s)
- S K Mishra
- School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia; Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - S Baidya
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - A Bhattarai
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - S Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - S Homagain
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - B Rayamajhee
- School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia
| | - A Hui
- School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia; Center for Ocular Research and Education, School of Optometry &Vision Science, University of Waterloo, Ontario, Canada
| | - M Willcox
- School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
2
|
Gharajalar SN, Tanhaee S, Omidzadeh M, Onsori M. Detection of Antimicrobial Resistance and Biofilm Production Among Staphylococcus pseudintermedius from Canine Skin Lesions. Microb Drug Resist 2023. [PMID: 37855899 DOI: 10.1089/mdr.2022.0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Aims: Staphylococcus pseudintermedius is an opportunistic pathogen also indicated as one of the major causes of skin infections in dogs. This study aimed to identify S. pseudintermedius isolated from canine skin lesions, evaluate their antibiotic resistance profile and biofilm production ability. Methodology: Lesions from 50 rural dogs with different skin lesions were sampled after pyoderma diagnosis by private practices. Bacterial species determination was investigated and susceptibility to nine antimicrobials were determined by means of Kirby-Bauer assay. Then seven antibiotic resistance genes, including mecA, blaZ, tetK, tetM, blaSHV, blaOXA-1, and blaTEM were screened by PCR. Moreover, biofilm formation ability of the strains was determined using the microtiter plate assay along with the presence of icaADBC genes. Results: A total of 37 (74%) isolates were identified as S. pseudintermedius. All S. pseudintermedius isolates were resistant to multiple drugs. Resistance to penicillin, amoxicillin-clavulanic acid, and cefazolin were higher than other antimicrobials. All the beta-lactam-resistant isolates carried blaZ, whereas mecA was found in 6 (16.21%) of them. Among tetracycline-resistant strains, the frequency of tetK and tetM determinants were 19 (90.47%) and 21 (100%), respectively. Finally, most cefazolin-resistant strains 31 (91.89%) were positive for blaTEM gene. The rate of biofilm production ability among S. pseudintermedius isolates was 35 (94.59%). Furthermore, the presence of icaA/D genes was detected in 35 (100%) and 29 (82.85%) of S. pseudintermedius strains, respectively. Conclusion: The high rates of antimicrobial resistance and biofilm production ability among S. pseudintermedius isolates, emphasize the urgent need to use more effective infection control policies and guidelines for antimicrobial use.
Collapse
Affiliation(s)
- Sahar Nouri Gharajalar
- Department of Pathobiology, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | - Sadegh Tanhaee
- Master Student of Veterinary Bacteriology, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | - Mahdieh Omidzadeh
- Master Student of Veterinary Bacteriology, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | | |
Collapse
|
3
|
Kalantar-Neyestanaki D, Mansouri S, Tadjrobehkar O, Isaei E. The frequency of adherence, biofilm-associated, Arginine Catabolic Mobile element genes, and biofilm formation in clinical and healthcare worker coagulase-negative staphylococci isolates. BMC Microbiol 2023; 23:222. [PMID: 37582708 PMCID: PMC10426181 DOI: 10.1186/s12866-023-02959-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Healthcare workers may pave the way for increased infections in hospitalized patients by coagulase-negative staphylococci (CoNS). Biofilm formation and antibiotic resistance are the major problems posed by CoNS in nosocomial infections. In this study, we determined biofilm production level and the distribution of biofilm-associated and virulence genes, including icaADBC, aap, bhp, atlE, embp, and fbe, as well as IS256, IS257, mecA, and ACME clusters (arc-A, opp-3AB) among 114 clinical (n = 57) and healthcare workers (n = 57) CoNS isolates in Kerman, Iran. RESULTS In this study, more than 80% (n = 96) of isolates were methicillin-resistant CoNS (MR-CoNS). Out of 114 isolates, 33% (n = 38) were strong biofilm producers. Strong biofilm formation was found to be significantly different between clinical and healthcare workers' isolates (P < 0.050). In addition, 28% (n = 32) of isolates were positive for icaADBC simultaneously, and all were strong biofilm producers. The prevalence of icaADBC, mecA, bhp, fbe, and IS256 in clinical isolates was higher than that in healthcare workers' isolates (P < 0.050). A significant relationship was observed between clinical isolates and the presence of icaADBC, mecA, bhp, and IS256. Although these elements were detected in healthcare workers' isolates, they were more frequent in clinical isolates compared to those of healthcare workers. CONCLUSIONS The high prevalence of ACME clusters in healthcare workers' isolates and biofilm formation of these isolates partially confirms the bacterial colonization in the skin of healthcare workers. Isolating MR-CoNS from healthcare workers' skin through similar genetic elements to clinical isolates, such as icaADBC, mecA, and IS256, calls for appropriate strategies to control and prevent hospital infections.
Collapse
Affiliation(s)
- Davood Kalantar-Neyestanaki
- Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Medical Microbiology (Bacteriology and Virology), Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahla Mansouri
- Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Medical Microbiology (Bacteriology and Virology), Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Omid Tadjrobehkar
- Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Medical Microbiology (Bacteriology and Virology), Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Elham Isaei
- Noncommunicable Diseases Research Center, Bam University Of Medical Sciences, Bam, Iran.
| |
Collapse
|
4
|
Tahmasbi F, Sheikhi R, Ashraf A, Mojtahedi A. Biofilm formation and molecular characterization of methicillin-resistant Staphylococcus aureus strains isolated from the patients, personnel, air and environment of ICUs. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
5
|
Parastan R, Kargar M, Solhjoo K, Kafilzadeh F. A synergistic association between adhesion-related genes and multidrug resistance patterns of Staphylococcus aureus isolates from different patients and healthy individuals. J Glob Antimicrob Resist 2020; 22:379-385. [PMID: 32169685 DOI: 10.1016/j.jgar.2020.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/16/2020] [Accepted: 02/26/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Biofilm -forming capacity of Staphylococcus aureus (S. aureus) as a commensal opportunistic bacterial species induce a growth in antibiotic resistance in chronic diseases. Since expression of biofilm- related genes and antibiotic resistance function are interdependent, the present study was an attempt to inquire biofilm formation and its relationship with antibiotic resistance in clinical isolates. METHODS 208 S. aureus clinical isolates from four major provinces of Iran were investigated in terms of presence of adhesion genes (icaA, icaD, icaB, icaC, fnbpA, fnbpB, clfA, clfB, cna, sasC, sasG and bap) using PCR. In addition, microtiter plate (Mtp) assay was performed to examine quantitative biofilm formation of the isolates and their antibiotic resistance patterns against 16 antibiotics determined upon CLSI criteria. RESULTS The results revealed high prevalence rate (almost 100%) of icaADBC and MSCRAMMs genes in the isolates. Moreover, bap gene was not detected in any of the tested clinical isolates. Based on phenotypic method 169 isolates (81.25%) were also found to have biofilm formation ability. Among 208 isolates, 98 (47.12%) isolates were multidrug resistant (MDR). Vancomycin, linezolid, nitrofurantoin and quinupristin/dalfopristin were the most effective drugs against MDR strains. Furthermore, the findings demonstrated a significant relationship between MDR and biofilm forming capacity. CONCLUSION Prevalence rate of adhesion- related genes was high in S. aureus from isolates in Iran ;so these genes might be expressed under certain conditions and cause emergence of MDR strains. Therefore, further investigations are necessary to prevent initial attachment based on new candidate adhesion genes for vaccine design.
Collapse
Affiliation(s)
- Raziey Parastan
- Department of Microbiology, Jahrom Branch, Islamic Azad University, Jahrom, Iran; Department of Microbiology, Jahrom University of Medical Sciences, Jahrom, Iran.
| | - Mohammad Kargar
- Department of Microbiology, Jahrom Branch, Islamic Azad University, Jahrom, Iran.
| | - Kavous Solhjoo
- Department of Parasitology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
| | - Farshid Kafilzadeh
- Department of Microbiology, Jahrom Branch, Islamic Azad University, Jahrom, Iran.
| |
Collapse
|
6
|
Mirzaei B, Faridifar P, Shahmoradi M, Shapouri R, Iranpour F, Haghi F, Ezzedin M, Babaei R, Mousavi SF. Genotypic and phenotypic analysis of biofilm formation Staphylococcus epidermidis isolates from clinical specimens. BMC Res Notes 2020; 13:114. [PMID: 32103775 PMCID: PMC7045379 DOI: 10.1186/s13104-020-04965-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/19/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Staphylococcus epidermidis is the primary causative agent of infections associated with indwelling biomaterials. Antibiotic susceptibility patterns, Biofilm formation capability, and screening of responsible genes in biofilm formation procedure in clinical isolates (icaA, icaB, icaC, icaD, sdrG, and atlE) were assigned as the main objectives in this study. The clinical samples were analyzed via standard biochemical assays for identifying different bacteria which were confirmed using the multiplex colony PCR method. Subsequently, biofilm-formation capability, antibiotic susceptibility testing, and the frequency of genes responsible for biofilm formation in the confirmed strains were checked. RESULTS Out of 183 clinical specimens 54 S. epidermidis isolates were detected by targeting a housekeeping gene (sesc) taking advantage of the PCR procedure. All of the strains were Biofilm forming producers. The in vitro biofilm formation assays determined that 45 (83.33%), 5 (9.26%), 4 (7.41%) were strong, moderate, and weak biofilm former strains respectively. Among the isolated strains, the specific frequencies of the biofilm-forming genes were specified to be (98%) for sdrG, (84%) for atlE, (80%) for icaC, and (70%) for icaD. Cefamandole and Amikacin are the most effective antibiotics in isolated strains. All strains were ascertained to be methicillin and amoxicillin/clavulanic acid resistant.
Collapse
Affiliation(s)
- Bahman Mirzaei
- Department of Microbiology and Virology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.,Department of Microbiology and Virology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Peyman Faridifar
- Department of Microbiology, Islamic Azad University, Zanjan Branch, Zanjan, Iran.,Department of Microbiology, Microbial Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Mostafa Shahmoradi
- Department of Microbiology, Islamic Azad University, Zanjan Branch, Zanjan, Iran.,Department of Microbiology, Microbial Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Reza Shapouri
- Department of Microbiology, Islamic Azad University, Zanjan Branch, Zanjan, Iran
| | - Fatemeh Iranpour
- Department of Microbiology and Virology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Fakhri Haghi
- Department of Microbiology and Virology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mahnaz Ezzedin
- Department of Microbiology, Islamic Azad University, Tehran Branch, Tehran, Iran
| | - Reyhaneh Babaei
- Department of Microbiology and Virology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.,Department of Microbiology, Microbial Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed Fazlollah Mousavi
- Department of Microbiology, Microbial Research Center, Pasteur Institute of Iran, Tehran, Iran.
| |
Collapse
|
7
|
Khashei R, Ebrahim-Saraie HS, Hadadi M, Ghayem M, Shahraki HR. The Occurrence of Nosocomial Pathogens on Cell Phones of Healthcare Workers in an Iranian Tertiary Care Hospital. Infect Disord Drug Targets 2018; 19:327-333. [PMID: 30173654 DOI: 10.2174/1871526518666180830165732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/18/2018] [Accepted: 08/17/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cell phones have become one of the necessary means of life and they are commonly used almost everywhere by every population. Colonized microorganisms on cell phones can be easily cross-transmitted. Given the widespread prevalence of nosocomial infections, this study aimed to determine the frequency of bacterial contamination and antibiotic resistance in cell phones of healthcare workers (HCWs) in a tertiary care hospital, from southwest of Iran. In this cross-sectional study conducted between April and June 2016, sampling were performed from cell phones of 25 nurses and 75 medical students. METHODS Samples were collected from each cell phone by a moistened cotton swap dipped in normal saline prior and after decontamination with available alcohol-based handrubs. Identification of bacterial isolates was performed by conventional microbiologic methods. Antibiotic susceptibility pattern of the isolates was determined using the disk diffusion method. The contamination rates of cell phones prior and after disinfection were 88% and 52%, respectively. Ninety-nine (71.2%) out of 139 isolated distinct bacterial colonies prior to cleaning were potentially nosocomial pathogens. Of them, staphylococci (88.9%) were the most prevalent bacteria, in which 40.9% were methicillin-resistant isolates. The majority of Gram-positive and - negative isolates were susceptible to the tested antimicrobials. Totally, contamination rate of cell phones was significantly reduced after decontamination. Regular disinfection of the hands and cell phones was significantly associated with reduction of colonization of the methicillin-resistant isolates. RESULT & CONCLUSION These findings emphasize the restricted use of cell phones and encourage the higher compliance with hygienic practices in hospitals to reduce the risk of nosocomial infections.
Collapse
Affiliation(s)
- Reza Khashei
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahtab Hadadi
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maysa Ghayem
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Raeisi Shahraki
- Department of Biostatistics and Epidemiology, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| |
Collapse
|