CORRELATION BETWEEN BIOFILM FORMATION AND ANTIBIOTIC TREATMENT FAILURE IN CHRONIC WOUND INFECTIONS IN IRAQI PATIENTS
DOI:
https://doi.org/10.5281/zenodo.19997297Keywords:
Biofilm; Chronic wounds; Antibiotic resistance; Treatment failure; Iraq; Pseudomonas aeruginosa; Staphylococcus aureus; Multidrug resistanceAbstract
Background: In Iraq, chronic wound infections are a significant burden on the public health system. There are many reasons for chronic wound infections including high rates of diabetes and injuries due to conflict, as well as inadequate healthcare infrastructure. Bacterial biofilms frequently form on chronic wounds and enable bacteria to persist and develop antibiotic resistance, thereby reducing treatment effectiveness. The purpose of this study was to assess the prevalence of biofilm-forming microorganisms in chronic wounds, to identify the dominant pathogens in these wounds, and to examine the statistical association between bacterial biofilm formation and antibiotic treatment failure among patients in Iraq.
Methods: A cross-sectional descriptive study of chronic wound patients was conducted at two major hospitals in Anbar Province, Iraq, from January through December of 2023. Two hundred fifteen patients with clinical diagnoses of chronic wounds were included in the study. Wound swabs and tissue biopsy samples were taken and processed for the culture and identification of aerobic and anaerobic bacteria. Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion and broth microdilution methods according to the 2023 CLSI guidelines. Biofilm formation was assessed using three methods (tissue culture plates (TCP), Congo red agar (CRA) & tubes) while the definition of treatment failure was the absence of improvement of the chronic wound after a minimum of 14 days of antibiotics based on identified pathogens.
Results: Of the 215 patients, 178 (82.8%) had positive cultures, yielding 212 bacterial isolates; 31.5% of the isolates were from polymicrobial infections. The bacterial organisms primarily isolated from the chronic wounds studied were Pseudomonas aeruginosa (27.5%), Staphylococcus aureus (24.7%), Klebsiella pneumoniae (18.0%), and Escherichia coli (12.4%). Biofilm was present in 71.3% of isolates, and 38.7% exhibited strong biofilm production. 68.0% of the S. aureus isolates were methicillin resistant (MRSA), and 72.4% of the P. aeruginosa isolates were carbapenem resistant. Isolates identified as strong biofilm producers showed significantly higher rates of multidrug resistance (MDR) and treatment failure than non-biofilm-producing isolates (p<0.001). Biofilm strength showed a strong positive correlation with clinical diagnosis of treatment failure (r = 0.74, p<0.001).
Conclusion: The results of this study indicate that biofilm production by bacterial pathogens is a strong and significant correlate to failure of antibiotic treatment in chronic wound infections in patients in Iraq. Routine assessment for bacterial biofilm should be included in microbiological clinical practice to promote individualized treatment regimens, alleviate pain and suffering, and also to rationalize the use of antibiotics in Iraqi Hospitals.
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