Genotype–Phenotype Association Between Biofilm-Related Genes and Multidrug Resistance in Uropathogenic Escherichia coli Isolated from Hospital-Acquired Urinary Tract Infections

A B S T R A C T Biofilm forming, multi-drug resistant uropathogenic Escherichia coli (UPEC) is a serious therapeutic and infection control problem of hospital-acquired UTIs. A cross-sectional study was conducted on 200 non-duplicate UPEC isolates from hospitalised patients to assess the genotype–phenotype association between the genes associated with biofilm and multidrug resistance. The microtitre-plate assay was used to assess biofilm formation, the Kirby–Bauer method was used to determine antimicrobial susceptibility, and the presence of genes associated with biofilm and resistance were detected using PCR. In summary, 31% of isolates were strong biofilm producers, 27% moderate, 24% weak and 18% were non-biofilm producers. FimH (78%), csgA (69%), pgaA (62%) and bssS (55%) were the most commonly found biofilmassociated genes. blaCTX-M (71%) and blaTEM (65%) were the most common resistance determinants, followed by blaSHV (51%), qnr (47%), blaNDM (38%) and blaOXA-48 (34%). As the strength of the biofilm increased, so did the carriage of the gene, and isolates with a multidrug resistance had an increased number of genes compared to those without them. The results of the study suggest a clinically significant connection between the genotype of biofilm and its phenotypic expression and antimicrobial resistance. Phenotypic and molecular surveillance may help to identify high-risk uropathogenic E. coli (UPEC) strains early and aid in directing treatment with susceptibility, as well as to prevent catheter-associated infections (CA-I) and facilitate antimicrobial-stewardship measures. These associations are supported with the recommendations of multicentre studies including gene-expression analysis, genomic sequencing and patient outcomes. Keywords: Uropathogenic Escherichia coli, biofilm, multidrug resistance, hospital-acquired urinary tract infection, antimicrobial resistance genes, polymerase chain reaction