Antimicrobial resistance and biofilm formation in implants related infections: Pathogens profiling and implants susceptibility

Abstract

Medical implant-associated infections are becoming increasingly hazardous because of the development of antimicrobial resistance (AMR). This study examined the burden of infectious medical implants (IMI), the possibility of biofilm generation, and the relationship between the type of implant material. A total of 135 infectious samples from medical implants were collected for this study. Matrix-assisted laser desorption Ionization time-of-flight (MALDI-TOF) was used to identify bacterial isolates. Disk diffusion and broth microdilution were used to test antimicrobial susceptibility, and biofilm potential was determined using a microtitre plate assay. The most prevalent pathogen was Acinetobacter baumannii (n=50, 37%), followed by Pseudomonas aeruginosa (n=42, 31.1%) and Escherichia coli (n=21, 15.6%). Antimicrobial susceptibility profiling showed MDR (n=89, 66%), XDR (n=13, 7%), PDR (n=2, 4%), and sensitive isolates (n=31,23%). The biofilm assay showed 66 (49%) strong, 46 (33%) moderate, and 23 (18%) weak biofilm producers, respectively. The strongest biofilms were found on the interlocking nails of the tibia and orthopaedic staples. A higher biofilm potential has been reported for stainless-steel implants. Binary logistic regression revealed that A. baumannii and stainless steel implants were significant predictors of strong biofilm formation. Similarly, E. coli and orthopedic staples were independently associated with multidrug resistance. Enterobacter hormaechie subsp. Oharae and Gemella haemolysans were reported first time in Pakistan among implants related infections. This study highlights the need for health professionals and policymakers to address concerns regarding implant-associated infections and alternative therapeutic strategies.