Clinical isolates from ICU patients show high rates of biofilm production : A descriptive study

Authors

  • Wignyo Santosa Department of Anaesthesia and Intensive Care Therapy, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia , Department of Anaesthesia and Intensive Care Therapy, Sultan Agung Islamic Hospital, Semarang, Indonesia
  • Herinto Himawan Department of Urology, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia
  • Dian Ayu Listiarini Department of Anaesthesia and Intensive Care Therapy, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia
  • Ahmad Umar Alfaruq Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia
Published 2025-12-14
Issue Vol. 16 No. 2 (2025): December 2025
Section Original Research Articles
DOI: https://doi.org/10.30659/sainsmed.v16i2.40814
Keywords: Biofilm, Intensive Care Unit (ICU), Antimicrobial resistance, Sepsis, Urinary tract infection, Wound infection

Abstract

Biofilm formation on indwelling devices promotes antimicrobial resistance and complicates management of ICU infections; comprehensive profiling of biofilm-producing pathogens in ICU settings is needed to inform infection control and stewardship.  Cross-sectional study (June–September 2023) of clinical isolates from ICU patients with sepsis, pneumonia, urinary tract infection, or wound infection at Sultan Agung Islamic Hospital, Semarang. Sixty-two isolates from sputum (endotracheal aspirates), pus/wound swabs, urine, and blood were identified by standard culture and biochemical methods. Biofilm production was assessed by the 96‑well microtiter plate crystal violet assay. All isolates produced biofilm: 50/62 (80.6%) strong, 9/62 (14.5%) moderate, and 3/62 (4.8%) weak. Gram‑negative organisms predominated: Klebsiella pneumoniae 18/62 (29.0%), Pseudomonas aeruginosa 17/62 (27.4%), and Escherichia coli 10/62 (16.1%). All P. aeruginosa isolates (17/17; 100%) exhibited strong biofilm formation across clinical conditions. K. pneumoniae was the most frequent cause of pneumonia (15/62; 24.2%), with 13/15 (86.7%) strong biofilm producers.  ICU isolates showed a high prevalence of strong biofilm production, primarily among Gram‑negative pathogens. These findings support the implementation of targeted surveillance, strict device care protocols, and antimicrobial stewardship strategies to address biofilm-associated resistance; larger multicenter longitudinal studies are recommended.

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© 2025 Author(s). Published by Sains Medika: Jurnal Kedokteran dan Kesehatan. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

How to Cite

Santosa, W., Himawan, H., Listiarini, D. A., & Alfaruq, A. U. (2025). Clinical isolates from ICU patients show high rates of biofilm production : A descriptive study. Sains Medika: Jurnal Kedokteran Dan Kesehatan, 16(2), 79-83. https://doi.org/10.30659/sainsmed.v16i2.40814

References

Al-Orphaly, M., Hadi, H. A., Eltayeb, F. K., Al-Hail, H., Samuel, B. G., Sultan, A. A., & Skariah, S. (2021). Epidemiology of Multidrug-Resistant Pseudomonas aeruginosa in the Middle East and North Africa Region. MSphere, 6(3): 1-15. https://doi.org/10.1128/msphere.00202-21

Cangui-Panchi, S. P., Ñacato-Toapanta, A. L., Enríquez-Martínez, L. J., Reyes, J., Garzon-Chavez, D., & Machado, A. (2022). Biofilm-forming microorganisms causing hospital-acquired infections from intravenous catheter: A systematic review. Current Research in Microbial Sciences, 3(100175): 1-12. https://doi.org/10.1016/j.crmicr.2022.100175

Chatterjee, S., Paul, P., Chakraborty, P., Das, S., Sarker, R. K., Sarkar, S., Das, A., & Tribedi, P. (2021). Cuminaldehyde exhibits potential antibiofilm activity against Pseudomonas aeruginosa involving reactive oxygen species (ROS) accumulation: a way forward towards sustainable biofilm management. 3 Biotech, 11(485): 1-12. https://doi.org/10.1007/s13205-021-03013-1

Chimi, L. Y., Noubom, M., Bisso, B. N., Singor Njateng, G. S., & Dzoyem, J. P. (2024). Biofilm Formation, Pyocyanin Production, and Antibiotic Resistance Profile of Pseudomonas aeruginosa Isolates from Wounds. International Journal of Microbiology, 2024 (1207536): 1-10. https://doi.org/10.1155/2024/1207536

Connie R. Mahon, D. C. L. (2019). Textbook of diagnostic microbiology. Elsevier Saunders. Missouri. USA.

Dargahi, Z., Hamad, A. A., Sheikh, A. F., Khosravi, N. A., Fard, S. S., Motahar, M., Mehr, F. J., Abbasi, F., Meghdadi, H., Bakhtiyariniya, P., Heydari, R., Moradi, M., & Dezfuli, A. A. Z. (2022). The biofilm formation and antibiotic resistance of bacterial profile from endotracheal tube of patients admitted to intensive care unit in Southwest of Iran. PLoS ONE, 17(11 November): 1–12. https://doi.org/10.1371/journal.pone.0277329

De Oliveira, D. M. P., Forde, B. M., Kidd, T. J., Harris, P. N. A., Schembri, M. A., Beatson, S. A., Paterson, D. L., & Walker, M. J. (2020). Antimicrobial resistance in ESKAPE pathogens. Clinical Microbiology Reviews, 33(3): 1–49. https://doi.org/10.1128/CMR.00181-19

Deglovic, J., Majtanova, N., & Majtan, J. (2022). Antibacterial and antibiofilm effect of honey in the prevention of dental caries: A recent perspective. Foods, 11(17): 1-14 . https://doi.org/10.3390/foods11172670

Fukami, Y., Koike, H., & Katsuno, M. (2022). Current perspectives on the diagnosis, assessment, and management of vasculitic neuropathy. Expert Review of Neurotherapeutics, 22 (11–12): . https://doi.org/10.1080/14737175.2022.2166831

Gogoi, M., & Sharma, A. (2021). Biofilm formation by bacteria isolated from intensive care units of a tertiary care hospital, with special relevance to its risk factors. International Journal of Research in Medical Sciences, 9(10): 2959-2965. https://doi.org/10.18203/2320-6012.ijrms20213915

Ibrahim, S., Al-Saryi, N., Al-Kadmy, I. M. S., & Aziz, S. N. (2021). Multidrug-resistant Acinetobacter baumannii as an emerging concern in hospitals. Molecular Biology Reports, 48(10), 6987–6998. https://doi.org/10.1007/s11033-021-06690-6

Khatoon, Z., McTiernan, C. D., Suuronen, E. J., Mah, T. F., & Alarcon, E. I. (2018). Bacterial biofilm formation on implantable devices and approaches to its treatment and prevention. Heliyon, 4(12): 1-36 . https://doi.org/10.1016/j.heliyon.2018.e01067

Levy, J. H., Neal, M. D., & Herman, J. H. (2018). Bacterial contamination of platelets for transfusion: strategies for prevention. Critical Care, 22(1), 1–8. https://doi.org/10.1186/s13054-018-2212-9

Oliveira, M. S., Borges, A. H., Mattos, F. Z., Semenoff, T. A. D. V., Segundo, A. S., Tonetto, M. R., Bandeca, M. C., & Porto, A. N. (2014). Evaluation of different methods for removing oral biofilm in patients admitted to the intensive care unit. Journal of International Oral Health: JIOH, 6(3): 61–64. https://pmc.ncbi.nlm.nih.gov/articles/PMC4109235/

Romário-Silva, D., Alencar, S. M., Bueno-Silva, B., Sardi, J. de C. O., franchin, m., carvalho, r. d. p. de, ferreira, t. e. de s. a., & rosalen, p. l. (2022). Antimicrobial activity of honey against oral microorganisms: Current reality, methodological challenges and solutions. Microorganisms, 10(12): 1–17. https://doi.org/10.3390/microorganisms10122325

Roy, R., Tiwari, M., Donelli, G., & Tiwari, V. (2018). Strategies for combating bacterial biofilms: A focus on anti-biofilm agents and their mechanisms of action. Virulence, 9(1): 522–554. https://doi.org/10.1080/21505594.2017.1313372

Zhang, D., Xia, J., Xu, Y., Gong, M., Zhou, Y., Xie, L., & Fang, X. (2016). Biological features of biofilm-forming ability of Acinetobacter baumannii strains derived from 121 elderly patients with hospital-acquired pneumonia. Clinical and Experimental Medicine, 16(1): 73-80. https://doi.org/10.1007/s10238-014-0333-2

Zhang, Z., Cao, Y., Li, Y., Chen, X., Ding, C., & Liu, Y. (2021). Risk factors and biofilm formation analyses of hospital-acquired infection of Candida pelliculosa in a neonatal intensive care unit. BMC Infectious Diseases, 21(1): 1–11. https://doi.org/10.1186/s12879-021-06295-1