Paper Title
Resistance Profiling of Staphylococcal Species Associated With Biofilms in Uti Patients From Hospitals of West Bengal, India

Urinary Tract Infections have been known as one of the most common nosocomial infections, leading to increased morbidity, especially the ones which are catheter associated and related to formation of biofilms.52 urine samples from patients with Urinary Tract Infections (females) were collected and pooled over a period of one and a half years, from various hospitals in and around Kolkata, W.B. Biochemical profiling showed 64% of the gram positive round colonies could grow on Phenyl Ethyl Alcohol Agar and Mannitol Salt Agar. The samples were Coagulase, Catalase and Oxidase positive. Molecular identification confirmed the presence of Staphylococcal species (significant at p≤0.05) along with enteric pathogens. Samples were tested with seventeen antibiotics from various groups namely Amikacin (30μg), Amoxicillin (05μg), Azithromicin (10μg), Cefotaxime (10μg), Ceftazidine (30μg), Chlroamphenicol (30μg), Ciprofloxacin (30μg), Cloxacillin (10μg), Co-trimoxazole (25μg), Levofloxacin (25μg), Methicillin (10μg), Nalidixic Acid (30μg,) Novobiocin (05μg), Ofloxacin (10μg), Piperacilin-Tazobactam (10μg), Sreptomycin (10μg) and Vancomycin (30μg). 86% of the samples showed resistance to majority of the antibiotics: Vancomycin, Methicillin, Nalidixic Acid, Ciprofloxacin, Amikacin and Co-trimoxazole used as single or in combinations. Susceptibility was seen towards Amoxicillin, Azithromicin, Cefotaxime, Ceftazidine, Chloramphenicol, Cloxacillin, Levofloxacin, Novobiocin, Ofloxacin, Piperacilin-Tazobactam and Streptomycin in various degrees. Enteric organisms found in the biofilms also showed resistance to different antibiotic groups. Lower MIC values were observed for Ceftazidine (0.125μg/ml), Levofloxacin (0.125μg/ml), Ofloxacin (0.25μg/ml) and Cloxacillin (0.25μg/ml) while higher MIC values were found towards Amoxicilin (4μg/ml), Cefotaxime (2μg/ml) and Piperacilin-Tazobactum(1 μg/ml) signifying that the organisms are in the intermediate stage. MAR index was observed around 0.2 for all the hospital samples. Resistance Pattern showed none of the samples to be resistant to all the six antibiotics when used in combination but all were resistant to at least one also at a significant level (p≤0.05). Various combinations of antibiotics revealed 21% of staph species to be resistant to Vancomycin and Methicillin, 14% against Methicillin and Co- trimoxazole, 12% against Amikacin and Cotrimoxazole, 11% against Nalidixic Acid and Ciprofloxacin and 11% were resistant to Methicillin, Amikacin and Ciprofloxacin, 7% against Vancomycin, Methicillin, Ciprofloxacin, Amikacin, Co- trimoxazole and, 7% against Vancomycin, Methicillin, Amikacin and Co-trimoxazole and 7% against Vancomycin, Methycillin and Ciprofloxacin in decreasing numbers. 4 % of staph samples were resistant to combinations of (N,C,A,Ct:V,M,C,A:M,C,A,N:V,M,A and M,A,Ct). This suggests growing resistance to the commonly used drugs related to UTI treatment. Isolation of Methicillin Resistant Staphylococcus spp. and MAR isolates in considerable numbers (p≤0.05) from the biofilms in association with the commonly found fecal and enteric pathogens in this study is of concern. Restricted use of antibiotics, proper quarantine and a judicious approach towards treatment is immediately called for. Key words- MAR, Resistance Profile, Pattern, Antibiogram, Methicillin Resistant Staphylococcal species, Biofilms, UTI.