Biofilm Formation and Planktonic Antimicrobial Susceptibility of Pseudomonas aeruginosa Isolates from Ventilator-associated Pneumonia Patients: A Pilot Study

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Background and Aim: Ventilator-associated pneumonia (VAP) is a severe infection occurring in mechanically ventilated ICU patients with Pseudomonas (P.) aeruginosa being the leading etiology.This pathogen frequently develops resistance to multiple antibiotics through biofilm formation.Hence, this study aims to evaluate the association between in-vitro biofilm production and antimicrobial susceptibility of P. aeruginosa in the planktonic state. Materials and Methods:This pilot study analyzed seven P. aeruginosa strains isolated from endotracheal aspirates of VAP patients at Dr. Soetomo General Hospital, Surabaya, Indonesia using Gram staining, oxidase testing, and VITEK® 2 system.Biofilm production was assessed via crystal violet staining, and antimicrobial susceptibility was determined by broth microdilution method.Statistical analysis was performed with the Mann-Whitney nonparametric test using GraphPad Prism 9 software.Results & Conclusion: Significant differences were observed in biofilm production and antimicrobial susceptibility of P. aeruginosa isolates from VAP patients against ceftazidime, piperacillin-tazobactam, cefepime, aztreonam, levofloxacin, and piperacillin.Strong biofilm producers showed higher resistance, especially to ceftazidime, piperacillin-tazobactam, and piperacillin, while weak biofilm producers had minimal resistance, except to ciprofloxacin, ticarcillin-clavulanate, and levofloxacin.Colistin showed the MIC values of ≤2 µg/mL against all isolates.Our findings indicated biofilm formation as a critical factor influencing resistance, emphasizing the need to consider biofilm-producing capacity when selecting treatment strategies for VAP caused by P. aeruginosa.

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