EVALUATION OF CELL SURFACE HYDROPHOBICITY AND BIOFILM PRODUCTION IN CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) PATHOGENS AND THEIR ASSOCIATION WITH DRUG-RESISTANCE

Abstract

Background: Catheter-associated urinary tract infections (CAUTIs) constitute for nearly 40% of hospital-acquired infections globally. Urinary catheterization facilitates microbial adhesion and biofilm formation, a key survival mechanism that enhances microbial tolerance to antimicrobial agents and environmental stresses. The biofilm production not only shields microorganisms from antimicrobial agents but also facilitates the transfer of antimicrobial resistance. Cell Surface Hydrophobicity (CSH) is an important virulence factor, also enhances microbial adherence, promoting colonization and persistent infection. Aims & Objectives: The study was conducted to detect organisms responsible for CAUTI, determine their antimicrobial susceptibility patterns, detect the ability to produce Biofilm and Cell Surface Hydrophobicity (CSH) and assess the correlation with drug resistance. Materials and Methods: A cross-sectional laboratory-based study was conducted over 5 months on 50 samples. Isolates were identified based on colony morphology, Gram staining characteristics, and standard biochemical tests, and tested for antimicrobial resistance. Biofilm production was assessed using two methods: Tissue Culture Plate method & Congo Red Agar method. The CSH was evaluated using an inverted microscope and the association between the two and drug resistance was assessed. Results: Among 50 isolates from CAUTI, Klebsiella pneumoniae (32%) was the most frequently isolated pathogen, followed by Escherichia coli (26%), Proteus mirabilis (20%), Pseudomonas aeruginosa (18%), and Candida albicans (4%). Biofilm production was seen in 42 (84%) isolates, while 26 (52%) exhibited CSH. Increased antimicrobial resistance was observed and multidrug resistance (MDR) was seen in 43 (86%) isolates. Fisher’s exact test s howed statistically significant association between the virulence factors and antimicrobial resistance as biofilm and CSH producing organisms had significantly higher resistance to Ampicillin (100% vs. 62.5%; p=0.003) and Amoxiclav (78.5% vs. 37.5%; p=0.030). Conclusion: Biofilm formation and CSH are highly prevalent among CAUTI uropathogens and are significantly associated with increased antimicrobial resistance and multidrug resistance. These factors contribute to bacterial adhesion, persistence, and treatment failure, emphasizing the importance for routine detection, proper catheter care practices and judicious antibiotic use.