Multidrug Resistant and Biofilm formation in Uropathogenic E.coli

Section: Research Paper
Issue
Vol. 48 No. 1 (2026): Volume 48 Issue 1
Pages
17-22

Keywords:

Biofilm, Multidrug resistant, Uro pathogenic E coli

Abstract

Background: Uropathogenic Escherichia coli (UPEC) is the main cause of urinary tract infections (UTIs). It causes a significant impact on public health due to its wide occurrence and healthcare costs. Many strains exhibit multidrug resistance (MDR) through different mechanisms such as biofilm and β-lactamase production, which enhances antibiotic tolerance and causes recurrent infections which necessitates the study of MDR and these causes.


Aim: to detect the relation between biofilm production and MDR in UPEC in Mosul City.


Patients and Methods: The study included 45 fully identified E. coli strain isolated from UTIs in Mosul City. Antimicrobial susceptibility was measured using Kirby-Bauer disk diffusion test according to guidelines and MDR was established as resistance to one agent in three or more groups. Biofilm measured using Tissue Culture Plate method, classifying the isolates from non-biofilm producer to strong producers based on optical density cut-off value.


Results: the study showed varying resistance level in different drugs, Amikacin, Ceftazidime, Cephalothin, Cefotaxime and Amoxiclav with resistance rate of 62.2%, 77.8%, 80%, 84.5%, 77,.8% and 86.7% respectively.  Imipenem exhibited no resistance while Norfloxacin had 11.1% resistance rate. MDR was recorded in 15 out of the 45 isolates and only 2 showed extensive drug resistance.  Biofilm production found in 73.3% of the isolates, categorized as high, moderate and mild in 27.3%, 60.6% and 12.1% respectively. Among those with MDR, 93.3% produced biofilm, with 46.7% demonstrating high production with significant statistical association.


Conclusion: Uropathogenic isolates revealed significant antimicrobial resistance specially Beta-lactam drugs whereas Imipenem was fully sensitive.  A significant relation was noted between MDR and biofilm production that need to address biofilm mediated tolerance in treatment of persistent MDR infections.

References

  1. GBD 2019 Antimicrobial Resistance Collaborators. Global mortality associated with 33 bacterial pathogens in 2019: a systemic analysis for the global burden of disease study 2019. Lancet 2022 Dec 17;400(10369):2221-2248. Doi: https://doi.org/10.1016/S0140-6736(22)02185-7.
  2. Whelan S, O'Grady MC, Corcoran D, Finn K, Lucey B. Uropathogenic Escherichia coli Biofilm-Forming Capabilities are not Predictable from Clinical Details or from Colonial Morphology. Diseases. 2020 Apr 30;8(2):11. Doi: https://doi.org/10.3390/diseases8020011
  3. Al-Hasnawy HH, Ridha JM, Jasim HH. The Dissemination of Multidrug Resistance (MDR) and Extensively Drug Resistant (XDR) among Uropathogenic E. coli (UPEC) Isolates from Urinary Tract Infection Patients in Babylon Province, Iraq. Baghdad Science Journal. 2019; 16(4): Article 24. Doi: https://doi.org/10.21123/bsj.2019.16.4(Suppl.).0986
  4. Rajput R, Sarsaiya S, Kumar N, Shekhawat S. Biofilm Formation in UPEC Isolates and its Association with Extended-Spectrum β-Lactamase Production and MDR in Hospitalized Patients: Gurugram, India. Int.J.Curr.Microbiol.App.Sci. 2021; 10(02): 673-685. Doi: https://doi.org/10.20546/ijcmas.2021.1002.081
  5. Alshaikh SA, El-Banna T, Sonbol F, Farghali MH. Correlation between antimicrobial resistance, biofilm formation, and virulence determinants in uropathogenic Escherichia coli from Egyptian hospital. Ann Clin Microbiol Antimicrob. 2024 Feb 24;23(1):20. Doi: https://doi.org/10.1186/s12941-024-00679-2.
  6. Ibrahim DR. Prevalence of Plasmid Mediated Qnra, Qnrb And Qnrs Among Clinical Escherichia Coli Isolated from Urinary Tract Infections In Duhok, Kurdistan Region Of Iraq. Sjuoz [internet]. 2023 nov. 13 [cited 2026 jan. 25];11(4):523 – 531. available from: https://sjuoz.uoz.edu.krd/index.php/sjuoz/article/view/1196
  7. Nasrollahian S, Graham JP, Halaji M. A review of the mechanisms that confer antibiotic resistance in pathotypes of E. coli. Front Cell Infect Microbiol. 2024 Apr 4;14:1387497. doi: https://doi.org/10.3389/fcimb.2024.1387497.
  8. Javed S, Mirani ZA, Pirzada ZA. Phylogenetic Group B2 Expressed Significant Biofilm Formation among Drug Resistant Uropathogenic Escherichia coli. Libyan J Med. 2021 Dec;16(1):1845444. doi: https://doi.org/10.1080/19932820.2020.1845444.
  9. Maslennikova IL, Nekrasova IV, Starčič Erjavec M, Karimova NV, Kuznetsova MV. Uropathogenic Escherichia coli Biofilms: Antibiotic Pressure and Interaction with Human Neutrophils. International Journal of Molecular Sciences. 2025; 26(19):9484. Doi: https://doi.org/10.3390/ijms26199484
  10. Ballén V, Cepas V, Ratia C, Gabasa Y, Soto SM. Clinical Escherichia coli: From Biofilm Formation to New Antibiofilm Strategies. Microorganisms. 2022 May 26;10(6):1103. Doi: https://doi.org/10.3390/microorganisms10061103.
  11. Barbara L. Zimme, Darcie E. Carpenter, German Esparza, Kevin Alby, Amelia Bhatnagar, et al. Performance Standards for Antimicrobial disk susceptibility tests. CLSI M02 14th edition March 2024.
  12. Kala Harika, Vishnu Prasad Shenoy, Nagalakshmi Narasimhaswamy1, Kiran Chawla. Detection of Biofilm Production and Its Impact on Antibiotic Resistance Profile of Bacterial Isolates from Chronic Wound Infections. Journal of Global Infectious Diseases 2020 Aug 29;12(3):129–134. Doi: https://doi.org/10.4103/jgid.jgid_150_19.
  13. Barbara Kot. Antibiotic Resistance Among Uropathogenic Escherichia coli. Polish Journal of Microbiology 2019, 68 (4): 403–415. Doi: https://doi.org/10.33073/pjm-2019-048.
  14. Nasrin Bahmani Noshin Abdolmaleki and Afshin Bahmani. Antimicrobial Resistance in Uropathogenic Escherichia coli Strains Isolated from Beasat Hospital in Sanandaj, West of Iran. Journal of pharmaceutical international 2020, 32(1): 32-36. Doi: https://doi.org/10.9734/jpri/2020/v32i130392.
  15. Goleanu CD, Vrancianu CO, Goleanu DA, Tantu MM, Csutak O. Trends in Antibiotic Resistance of Escherichia coli Strains Isolated from Clinical Samples (2019–2023): A Hospital-Based Retrospective Analysis. Pathogens. 2025; 14(9):927. Doi: https://doi.org/10.3390/pathogens14090927
  16. Fu Y, Zhao F, Lin J, Li P, Yu Y. Antibiotic susceptibility patterns and trends of the gram-negative bacteria isolated from the patients in the emergency departments in China: results of SMART 2016-2019. BMC Infect Dis. 2024 May 17;24(1):501. Doi: https://doi.org/10.1186/s12879-024-09294-0.
  17. Wu X, Li X, Yu J, Fan C, Shen M, Li X. Investigation of in vitro susceptibility and resistance mechanisms to amikacin among diverse carbapenemase-producing Enterobacteriaceae. BMC Med Genomics. 2024 Oct 1;17(1):240. Doi: https://doi.org/10.1186/s12920-024-02016-0.
  18. Lin IF, Lai CH, Lin SY, Lee CC, Lee NY, Liu PY, et al. Mutant Prevention Concentrations of Ciprofloxacin and Levofloxacin and Target Gene Mutations of Fluoroquinolones in Elizabethkingia anophelis. Antimicrob Agents Chemother. 2022 Jul 19;66(7):e0030122. Doi: https://doi.org/10.1128/aac.00301-22.
  19. Almakrami M, Salmen M, Aldashel YA, Alyami MH, Alquraishah N, AlZureea M, et al. Prevalence of multidrug-, extensively drug-, and pandrug-resistant bacteria in clinical isolates from King Khaled Hospital, Najran, Saudi Arabia. Discover Medicine. 2024; 1:108. Doi: https://doi.org/10.1007/s44337-024-00094-8.
  20. Saleem Z, Haseeb A, Abuhussain SSA, Moore CE, Kamran SH, Qamar MU, et al. Antibiotic Susceptibility Surveillance in the Punjab Province of Pakistan: Findings and Implications. Medicina (Kaunas). 2023 Jun 28;59(7):1215. doi: https://doi.org/10.3390/medicina59071215.
  21. Assefa M, Tigabie M, Amare A, Girmay G, Geteneh A, Ayalew G, et al. Emergence of extensively and pan-drug resistance in clinical bacterial isolates: A systematic scoping review from Ethiopian public health perspective. PLoS Negl Trop Dis. 2025 Aug 28;19(8):e0013363. Doi: https://doi.org/10.1371/journal.pntd.0013363.
  22. Padmaja N, Deborah Purushottam M, Srilalitha V. Prevalence of multi-drug resistant, extensively drug resistant, pan drug resistant bacteria from intensive care units of a tertiary care teaching hospital, Amalapuram, India. Bioinformation. 2025 Jun 30;21(6):1475-1480. Doi: https://doi.org/10.6026/973206300211475.
  23. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012 Mar;18(3):268-81. Doi: https://doi.org/10.1111/j.1469-0691.2011.03570.x
  24. Zahra'a Hadi Hasnawi, Suad Abdulhadi Al-Hilu. Investigating The Relationship Between Biofilm Formation and Antibiotic Resistance Patterns of Escherichia Coli Isolated from Various Sources. Al-Kufa University Journal for biology. 2025 17(1):53-63 Doi: https://doi.org/10.36320/ajb/v17.i1.18070
  25. Vestby LK, Grønseth T, Simm R, Nesse LL. Bacterial Biofilm and its Role in the Pathogenesis of Disease. Antibiotics (Basel). 2020 Feb 3;9(2):59. Doi: https://doi.org/10.3390/antibiotics9020059.
  26. Sheriff R, Sheena A. Assessment of Biofilm Production in Clinically Significant Isolates of Staphylococcus epidermidis and Comparison of Qualitative and Quantitative Methods of Biofilm Production in a Tertiary Care Hospital. Int J Sci Stud 2016;4(6):41-46. Doi: https://doi.org/10.17354/ijss/2016/482
  27. Yahya MFZR, Jalil MTM, Jamil NM, Nor NHM, Alhajj N, Siburian R, et al. Biofilms and multidrug resistance: an emerging crisis and the need for multidisciplinary interventions. Front Bioeng Biotechnol. 2025 Jun 25;13:1625356. Doi: https://doi.org/10.3389/fbioe.2025.1625356.
  28. Facchin A, Filipe J, Mauri I, Tagliasacchi F, Grilli G, Vitiello T, et al. Antimicrobial Resistance and Biofilm-Forming Ability in ESBL-Producing and Non-ESBL-Producing Escherichia coli and Klebsiella pneumoniae Isolated from Canine Urinary Samples from Italy. Antibiotics. 2025; 14(1):31. Doi: https://doi.org/10.3390/antibiotics14010031
  29. Donadu MG, Mazzarello V, Cappuccinelli P, Zanetti S, Madléna M, Nagy ÁL, et al. Relationship between the Biofilm-Forming Capacity and Antimicrobial Resistance in Clinical Acinetobacter baumannii Isolates: Results from a Laboratory-Based In Vitro Study. Microorganisms. 2021; 9(11):2384. Doi: https://doi.org/10.3390/microorganisms9112384

Author

Asmaa Z. Shetawi

Department of Microbiology, College of Medicine, University of Mosul, Mosul, Iraq

ORCID

Identifiers

DOI: 10.33899/acmm.v48.i1.61355

Download this PDF file
PDF

Statistics

How to Cite

1.
Multidrug Resistant and Biofilm formation in Uropathogenic E.coli. Ann. coll. Med. Mosul [Internet]. 2026 Jun. 29 [cited 2026 Jul. 18];48(1):17-22. Available from: https://mmed.uomosul.edu.iq/index.php/mmed/article/view/61355

How to Cite

1.
Multidrug Resistant and Biofilm formation in Uropathogenic E.coli. Ann. coll. Med. Mosul [Internet]. 2026 Jun. 29 [cited 2026 Jul. 18];48(1):17-22. Available from: https://mmed.uomosul.edu.iq/index.php/mmed/article/view/61355