Investigation of efflux pumps and biofilm formation in Escherichia coli isolated from various clinical sources in Baghdad, Iraq

عبد السلام محمد جلد

doi:10.69923/vz9kmf92

Authors

عبد السلام محمد جلد جامعة ديالى Author

DOI:

https://doi.org/10.69923/vz9kmf92

Keywords:

Escherichia coli, Efflux pump, Biofilm, Phenotypic detection

Abstract

The rapid emergence of antibiotic-resistant Escherichia coli poses a major global health challenge, particularly in clinical settings where infections are common and increasingly difficult to treat. Among the principal mechanisms contributing to antimicrobial resistance are efflux pumps, which reduce intracellular antibiotic concentrations, and biofilm formation, a structured survival strategy that promotes bacterial persistence and decreases susceptibility to antimicrobial agents. This study aimed to phenotypically detect efflux pump activity and biofilm formation in E. coli isolates obtained from various clinical sources in Baghdad, Iraq, and to evaluate their contribution to multidrug resistance and their association with antimicrobial susceptibility patterns. A total of 305 clinical specimens were collected from patients with urinary tract infections, diarrhea, bloodstream infections, wounds, burns, and respiratory tract infections. Fifty E. coli isolates were identified using conventional microbiological methods and the VITEK 2 automated system. Antimicrobial susceptibility testing was performed against 13 commonly used antibiotics using the disk diffusion method, and the minimum inhibitory concentration (MIC) of colistin was determined. Based on their resistance profiles, 24 multidrug-resistant isolates were selected for further phenotypic analysis. High resistance rates were observed for ampicillin (94%) and cefoxitin (84%), whereas fosfomycin demonstrated complete effectiveness against urinary isolates. Among the multidrug-resistant isolates, 79.1% exhibited biofilm-forming ability, classified as strong (20.8%), moderate (20.8%), and weak (37.5%). Furthermore, 95.8% of the isolates showed efflux pump activity. Both biofilm formation and efflux pump activity were strongly associated with resistance to β-lactams, tetracyclines, quinolones, and cephalosporins.

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