Correlation of Biofilm and Extended Spectrum Beta-Lactamase Production among Gram-negative Bacteria in a Pediatric Hospital – Gaza Strip, Palestine

Abstract

The Background: Gram-negative bacilli (GNB) are the most frequent cause of community-acquired infections, health care associated infections, and opportunistic infections. The combined effects of biofilm formation and beta-lactamase production play an important role in facilitating the widespread spread of MDR GNB strains.

Objectives: Detection of biofilm formation among GNB, evaluation of their antibiotic susceptibility profile, and assessment of extended spectrum beta lactamase (ESBL) production. Furthermore, to investigate the relationship between ESBL production and biofilm formation in the pediatric patient population at Al Nasser Hospital.

Methods: A total of 89 GNB isolates were isolated from different clinical samples collected at Al Naser referral pediatric hospital. The isolates were tested for ESBL production using the double disk synergy test (DDS). Antimicrobial susceptibility testing was done using the Kirby-Bauer disk diffusion method. Quantitative detection of biofilm production was performed using the microtiter plate method.

Results: Out of the 89 isolates, 65 (73%) demonstrated the ability to produce biofilm. Among these, 47 isolates (52.8%) were identified as ESBL producers. A statistically significant correlation was  observedwas observed between drug resistance (ESBL production) and biofilm formation, with a p-value of 0.0016. Meropenem and amikacin had the highest rates of overall susceptibility, with susceptibility rates of 69.9% and 69.7%, respectively. The frequencies of P. aeruginosa, E. coli, K.pneumoniae, A. spp., Proteus mirabilis, and Serratia marcescens were 34.8%, 31.4%, 29.2%, 2.2%, 1.1%, and 1.1% respectively. Biofilm formation in the previous bacteria was 80.6%, 64.3%, 73.1%, 100%, 100%, and 0% respectively.

 Conclusion: Antibacterial resistance was correlated with the production of biofilm and ESBL. The coexistence of ESBL and biofilm in GNB is of great public health concern. These factors contribute to the development of chronic, persistent, and recurrent infections, leading to significant morbidity and mortality rates. They therefore represent a serious health crisis.