Biofilm–Antibiotic Resistance Interplay in Chronic Wound Gram-Negative Pathogens: Insights From an Indonesian Tertiary Hospital

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Abstract

Biofilm-forming bacteria hinder wound healing and increase antibiotic resistance, complicating the diagnosis and treatment of chronic wound infections. This study aims to investigate the antimicrobial resistance profiles of biofilm-forming Gram-negative bacteria isolated from chronic wound infections in patients at an Indonesian tertiary hospital. A total of 75 Gram-negative bacterial isolates from 60 patients with chronic wound infections were identified and tested for antimicrobial susceptibility. Biofilm formation was assessed using the microtiter plate assay. The Spearman correlation test was used to analyze the relationship between antimicrobial resistance and biofilm production. Gram-negative bacteria accounted for 80% of all isolates. Surgical site infections (SSIs) were the most common wound type. Biofilm-forming ability varied: 45% of isolates were weak, 38.3% moderate, and 16.7% strong producers. Escherichia coli was the dominant species, mainly linked to SSIs, showed weak or no biofilm formation. Klebsiella pneumoniae and Pseudomonas aeruginosa were also prevalent. A weak positive correlation was found between biofilm formation and resistance to amikacin, gentamicin, and meropenem. An inverse correlation was observed with ceftazidime, while no correlation was found with aztreonam, cefepime, or ciprofloxacin. As a conclusion, a weak but significant correlation exists between biofilm production and resistance to certain antibiotics in Gram-negative bacteria.