Original Research Article
Year: 2019 | Month: January | Volume: 9 | Issue: 1 | Pages: 21-27
Biofilm Formation and Antibiotic Resistance of Uropathogens in Pregnant Women with Symptomatic and Asymptomatic Bacteriuria
Dr Parag Hawaldar1, Dr Kavita Hawaldar2
1Associate Professor, Prakash Institute of Medical Sciences, Urun, Islampur, Maharshtra
2Professor, Prakash Institute of Medical Sciences, Urun, Islampur, Maharshtra
Corresponding Author: Dr Kavita Hawaldar
Introduction: Urinary tract infection is more common in women than men and the susceptibility increases further during pregnancy. Higher incidence of UTI in women can be attributed to factors like shortness of urethra, close proximity of urethra to anus, sexual intercourse pregnancy and catheters. The detection of bacteriuria allows an approach to be made for the prevention of chronic UTI and avoid complications in pregnancy at an early stage. Bacteria adhere to the surfaces, initially in a reversible association and then through irreversible attachment, and eventually develop into an adherent biofilm of highly structured and cooperative consortia .The presence of biofilms also explains the nature of chronic infections that keep recurring after antibiotic treatment ceases. Clearly, biofilm infections in urogenital tissue are associated with significant morbidity and mortality.
Materials & Methods: A total of 100 midstream urine samples from pregnant females were collected aseptically. The samples were cultured on MacConkey agar and incubated at 37⁰C for 24 hrs. Urine culture yielding colony counts of>10⁵organisms/ml, along with >10pus cells/HPF of a centrifuged urine sample were interpreted as diagnostic of bacteriuria. Identification of isolates was performed by colony morphology, gram staining and standard biochemical tests. Antibiotic sensitivity testing against commonly used antibiotics was done by Kirby Bauer disc diffusion method. Extended spectrum Beta lactamase (ESBL) producers were detected by disc potentiation method. Detection of biofilms was done by the Tissue Culture Plate assay described by Christensen et al considered as standard test for detection of biofilm formation. Optical density (OD) of stained adherent bacteria was determined with a micro ELISA auto reader at wavelength of 570 nm. These OD values were considered as an index of bacteria adhering to surface and forming biofilms.
Results: Out of 100 pregnant females investigated for UTI 30 (30%) had significant bacteriuria. Out of 30% showing significant growth 23 (23%) were symptomatic and 7 (7%) were asymptomatic. Out of 30 urine samples showing significant growth of organisms E.coli was the predominant isolate 18 (60%) followed by Klebsiella pneumoniae 7(23.3%), Enterococcus 2 (6.6%), Pseudomonas aeruginosa2 (6.6%) and Staphylococcus aureus1 (3.33%). Out of 27 gram negative isolates 14(51.8%) were resistant to Amoxicillin, 11(40.7%) to Norfloxacin, 9(33.3%) to Cotrimoxazole, 6(22.2%) to Nitrofurantoin, 4 (14.8%) to Ciprofloxacin, 4 (14.8%) to Nalidixic acid & 2 (7.4%) to Amoxicillin clavulanic acid.
Biofilm production among uropathogens was detected by Tissue culture plate method in 9 of 27 isolates mainly from E.coli, Pseudomonas and Klebsiella.
Conclusion: Significant correlation between Biofilm production and multidrug resistance was seen in the study. It is therefore recommended that routine microbiological analysis, antibiotic sensitivity test of mid-stream urine samples and biofilm detection of pregnant females whether symptomatic or asymptomatic should be carried out so as enhance in the administration of drugs for the treatment and management of UTI in pregnancy and prevent further complications.
Key words: Biofilm, Antibiotic resistance, Urinary tract Infection