Biofilm Formation and Methicillin Resistance of Staphylococcus aureus Isolated from Clinical Samples
Keywords:MDR, Biofilm, MRSA, TCP, TM, Gaza strip, Palestine
Background: Staphylococcus aureus including methicillin resistant S. aureus (MRSA) is one of the most effective biofilm-forming organisms, biofilm contribute in protecting the microorganism from host defenses and prevent the effective penetration of antimicrobial agents. Biofilm formation is considered as an important contributing factor for the initiation and establishment of chronic infection by S. aureus and known as a major obstacle in the treatment of S. aureus infections is their ability to develop resistance to antimicrobials.
Aims : To screen clinical Staphylococcus aureus including MRSA isolates for their biofilm forming abilities and their association with antimicrobial resistance.
Methods: A total of 196 clinical isolates of S. aureus were obtained from different sample sources using standard microbiological techniques from three major hospitals in Gaza strip. Biofilm formation of these isolates was determined by tissue culture plate (TCP) method and tube adherence method (TM). Antimicrobial susceptibility test was performed using the modified Kirbyâ€“Bauer disk diffusion method as per Clinical and Laboratory Standards Institute guidelines. MRSA was detected using the cefoxitin disk test.
Results: Biofilm formation was observed in 174 (88.8 %) and in 145 (74.0%) isolates of S. aureus via TCP method and TM, respectively. The highest resistance percent was for penicillin (92.9%), followed by cefoxitin (80.6%) and oxacillin (67.9%), while the lowest resistance percent was for linezolid and ceftaroline (1%). Among the 196 isolates 71.4% (N=140) were classified as MDR with a MAR index (â‰¥ 0.2).
A total of 158 isolates (80.6%) were identified as MRSA distributed as 90.4%, 79.4% and 70.9% from Al-Shifa, Al-Nasser pediatrics and Al-Aqsa hospitals respectively. Large proportions (82.1%) of biofilm producers were identified as MRSA. Biofilm-producing MRSA exhibited a higher percent (90.5%) when compared with the biofilm non-producer MRSA (9.5%). Importantly, 89.2% of biofilm-producing S. aureus were multidrug resistant.
Conclusions: S. aureus isolates possessed high biofilm-forming ability. Biofilm-producing strains have very high tendency to exhibit antimicrobial resistance, multidrug resistance and methicillin resistance. Regular surveillance of biofilm formation by S. aureus and their antimicrobial resistance profile may lead more success in treating S. aureus infections.
Keywords: Biofilm, MDR, MRSA, TCP, TM, Gaza strip, Palestine.
Devriese L, Vancanneyt M, Baele M, Vaneechoutte M, De Graef E, Snauwaert C, Decostere A. Staphylococcus pseudintermedius sp. nov., a coagulase-positive species from animals. International journal of systematic and evolutionary microbiology 2005; 55(4): 1569-1573.
Taha, A. Prevalence of Methicillinâ€“resistant Staphylococcus aureus nasal carriage among patients and healthcare workers in Hemodialysis centers in North West Bank-Palestine. Faculty of graduate studies 2010, Al-Najah National University. Unpublished thesis.
de Kraker M, Wolkewitz M, Davey P, Grundmann H, Group B. The clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin resistant Staphylococcus aureus bloodstream infections. Antimicrobial agents and chemotherapy 2011; 55(4): 1598-1605.
DeLeo F, Otto M, Kreiswirth B, Chambers H. Community-associated meticillin-resistant Staphylococcus aureus. The Lancet 2010; 375(9725): 1557-1568.
Costello M. Single nucleotide polymorphism (SNP)-genotyping of Community Acquired Methicillin-Resistant Staphylococcus aureus, including the subtyping of PVL toxin producers using Real-Time PCR. MSC. Thesis 2010; Queensland University of Technology, Queensland, Australia.
DeLeo F, Chambers H. Reemergence of antibiotic-resistant Staphylococcus aureus in the genomics era. The Journal of clinical investigation 2009; 119(9): 2464-2474.
Klevens R, Morrison M, Nadle J, Petit S, Gershman K, Ray S, Townes J. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007; 298(15): 1763-1771.
Bogino P, Oliva M, Sorroche F, Giordano W. The role of bacterial biofilms and surface components in plant-bacterial associations. International journal of molecular sciences 2013; 14(8): 15838-15859.
Gowrishankar S, Duncun Mosioma N, Karutha Pandian S. Coral-associated bacteria as a promising antibiofilm agent against methicillin-resistant and-susceptible Staphylococcus aureus biofilms. Evidence-Based Complementary and Alternative Medicine 2012; 2012: 16.
Gurjala A, Geringer M, Seth A, Hong S, Smeltzer M, Galiano R, Mustoe T. Development of a novel, highly quantitative in vivo model for the study of biofilmâ€impaired cutaneous wound healing. Wound repair and regeneration 2011; 19(3): 400-410.
Walton K. Murine models of Staphylococcus aureus biofilm infections and therapeutic protein A vaccination. MSC. Thesis 2013, Colorado State University, fortCollins, Colorado.
Kiedrowski M, Horswill A. New approaches for treating staphylococcal biofilm infections. Annals of the New York Academy of Sciences 2011; 1241(1): 104-121.
Schierle C, De la Garza M, Mustoe T, Galiano R. Staphylococcal biofilms impair wound healing by delaying reepithelialization in a murine cutaneous wound model. Wound repair and regeneration 2009; 17(3): 354-359.
CLSI. Clinical and Laboratory Standard Instiute, performance standards for antimicrobial susceptibility testing 2017. Retrieved from: www.facm.ucl.ac.be/intranet/CLSI/CLSI-2017-M100-S27.pdf. (Access date: 10 April, 2018).
Al Laham N, Rohde, H, Sander G, Fischer A, Hussain M, Heilmann C, Becker K. Augmented expression of polysaccharide intercellular adhesin in a defined Staphylococcus epidermidis mutant with the small-colony-variant phenotype. Journal of bacteriology 2007; 189(12): 4494-4501.
Elmanama A, Abu-Dan R, Eqtifan R, Shomar A, Rifi M. Evaluation of Biofilm Formation of Pseudomonas aeruginosa Isolated from Al-Shifa Hospital and their Susceptibility to Acetic Acid. IUG Journal of Natural Studies 2018; 27(1): 19-25.
AlcarØŒz L, Satorres S, Lucero R, Centorbi O. Speciesidentification, slime production and oxacillin susceptibility in coagulase-negative staphylococci isolated from nosocomial specimens. Brazilian Journal of Microbiology 2003; 34(1): 45-51.
Belbase A, Pant, N, Nepal K, Neupane B, Baidhya R, Baidya R, Lekhak B. Antibiotic resistance and biofilm production among the strains of Staphylococcus aureus isolated from pus/wound swab samples in a tertiary care hospital in Nepal. Annals of clinical microbiology and antimicrobials 2017; 16(1): 15.
Endimiani A, Blackford M, Dasenbrook E, Reed M, Bajaksouszian S, Hujer A, Rice L. Emergence of linezolid-resistant Staphylococcus aureus after prolonged treatment of cystic fibrosis patients in Cleveland, Ohio. Antimicrobial agents and chemotherapy 2011, 55(4): 1684-1692.
Elmanama A, Aljubb A, Philippe H, Elnabris K, Adnan A, Afifi S, Elfara F. Antimicrobial resistance of Staphylococcus aureus, fecal streptococci, Enterobacteriaceae and Pseudomonas aeruginosa isolated from the coastal water of the Gaza strip-Palestine. The international Arabic Jornal of Antimicrobial Agents 2016; 6 (3).
El Aila N, Al Laham N, Ayesh B. Nasal carriage of methicillin resistant Staphylococcus aureus among health care workers at Al Shifa hospital in Gaza Strip. BMC infectious diseases 2017; 17(1): 28.
Elbayoumi Y. Epidemiology of Septicemia at Neonatal Intensive Care Units in Gaza City Hospitals. MSC. Thesis 2011; The Islamic University-Gaza, Gaza Strip, Palestine.
Hujier A, Saleem N. Detection of methicillin-resistant Staphylococcus aureus in nosocomial infections in Gaza Strip. MSC. Thesis 2006; The Islamic University-Gaza, Gaza Strip, Palestine.
Elmanama A, Abdelateef N. Antimicrobial Resistance of Enteric
Pathogens Isolated from Acute Gastroenteritis Patients in Gaza
strip, Palestine. The International Arabic Journal of Antimicrobial
Agents 2012; 2(4).
Al Laham N, Mediavilla J, Chen L, Abdelateef N, Elamreen F, Ginocchio C, Kreiswirth B. MRSA clonal complex 22 strains harboring toxic shock syndrome toxin (TSST-1) are endemic in the primary hospital in Gaza, Palestine. PLoS One 2015; 10(3).
Rokney A, Baum M, Ben-Shimol S, Sagi O, Anuka E, Agmon V, Danino D. Dissemination of the Methicillin Resistant Staphylococcus aureus (MRSA) Pediatric Clone (ST5-T002-IV-Pvl+) as a Major Cause of Community Associated (CA) Staphylococcal Infections in Bedouin Children, Southern Israel. The Pediatric Infection Disease Journal 2017; 38(3): 230-235
Borg M, De Kraker M, Scicluna E, van de Sande-Bruinsma N, Tiemersma E, Monen J, Grundmann H. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in invasive isolates from southern and eastern Mediterranean countries. Journal of Antimicrobial Chemotherapy 2007; 60(6): 1310-1315.
Neopane P, Nepal H, Shrestha R, Uehara O, Abiko Y. In vitro biofilm formation by Staphylococcus aureus isolated from wounds of hospital-admitted patients and their association with antimicrobial resistance. International journal of general medicine 2018; 11: 25.
Moghadam S, Pourmand M, Aminharati F. Biofilm formation and antimicrobial resistance in methicillin-resistant Staphylococcus aureus isolated from burn patients, Iran. The Journal of Infection in Developing Countries 2014; 8(12): 1511-1517.
Ãguila-Arcos S, Ãlvarez-RodrÃguez I, Garaiyurrebaso O, Garbisu C, Grohmann, E, Alkorta I. Biofilm-forming clinical Staphylococcus isolates harbor horizontal transfer and antibiotic resistance genes. Frontiers in microbiology 2017; 8: 2018.
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