Prevalence and Impact of Biofilms on Bloodstream and Urinary Tract Infections: A Systematic Review and Meta-Analysis

Abstract

This study sought to assess the prevalence and impact of biofilms on two commonly biofilm-related infections, bloodstream and urinary tract infections (BSI and UTI). Separated systematic reviews and meta-analyses of observational studies were carried out in PubMed and Web of Sciences databases from January 2005 to May 2020, following PRISMA protocols. Studies were selected according to specific and defined inclusion/exclusion criteria. The obtained outcomes were grouped into biofilm production (BFP) prevalence, BFP in resistant vs. susceptible strains, persistent vs. non-persistent BSI, survivor vs. non-survivor patients with BSI, and catheter-associated UTI (CAUTI) vs. non-CAUTI. Single-arm and two-arm analyses were conducted for data analysis. In vitro BFP in BSI was highly related to resistant strains (odds ratio-OR: 2.68; 95% confidence intervals-CI: 1.60–4.47; p < 0.01), especially for methicillin-resistant Staphylococci. BFP was also highly linked to BSI persistence (OR: 2.65; 95% CI: 1.28–5.48; p < 0.01) and even to mortality (OR: 2.05; 95% CI: 1.53–2.74; p < 0.01). Candida spp. was the microorganism group where the highest associations were observed. Biofilms seem to impact Candida BSI independently from clinical differences, including treatment interventions. Regarding UTI, multi-drug resistant and extended-spectrum β-lactamase-producing strains of Escherichia coli, were linked to a great BFP prevalence (OR: 2.92; 95% CI: 1.30–6.54; p < 0.01 and OR: 2.80; 95% CI: 1.33–5.86; p < 0.01). More in vitro BFP was shown in CAUTI compared to non-CAUTI, but with less statistical confidence (OR: 2.61; 95% CI: 0.67–10.17; p < 0.17). This study highlights that biofilms must be recognized as a BSI and UTI resistance factor as well as a BSI virulence factor.

Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update

“…As for UTIs, multi-resistant E. coli was observed to be the predominant strong biofilm producer. The above-mentioned study clearly proved that biofilms must be assumed to be a BSI and UTI resistance factor [33].…”

“…Microorganisms can survive not only in planktonic form, but also they frequently colonize medical devices and form mono-or inter-species communities. Biofilms have subsequently become more resistant to conventional drugs, often resulting in chronic infections in patients [17,[32][33][34]. Svensson et al (2021) noted that a strong biofilm production was significantly associated with recurrent infection [34].…”

“…Svensson et al (2021) noted that a strong biofilm production was significantly associated with recurrent infection [34]. According to a meta-analysis of PubMed and Web of Sciences databases from January 2005 to May 2020 published by Pinto et al (2021), strong biofilm producers tested in vitro and associated with BSI were strongly represented among the resistant strains. Methicillin-resistant S. aureus (MRSA) was mainly mentioned.…”

Pseudomonas aeruginosa Biofilm Formation and Its Control

“…Among various biofilm-associated infections, UTIs are the most common bacterial infections affecting humans and serve as a public health issue [21]. Nevertheless, in 2017, bloodstream infections associated with biofilms were ranked as the 12th leading cause for death with an overall mortality rate between 15-30% [22].…”

Sonochemically engineered nano-enabled zinc oxide/amylase coatings prevent the occurrence of catheter-associated urinary tract infections

“…Indwelling medical devices such as urinary catheters have become an indispensable part of the modern medicine, aiding to improve the patient's quality of life [1]. However, all types of urinary catheters are vulnerable to microbial contamination and create an ideal environment for pathogenic bacteria to form biofilms originating severe urinary tract infections (UTIs) [2]. Catheter-associated UTIs (CAUTIs) account for over 40% of all hospital-acquired infections and more than 80% of all UTIs [3].…”