Original Article

Characterization of Staphylococcus aureus Biofilm Formation in Urinary Tract Infection


Background: The aim of this study was to investigate the antibiotic susceptibility pattern as well as the phenotypic and genotypic biofilm formation ability of Staphylococcus aureus isolates from patients with urinary tract infection (UTI).

Methods: A total of 39 isolates of S. aureus were collected from patients with UTI. The antibiotic susceptibility patterns of the isolates were determined by the Kirby-Bauer disk-diffusion. We used the Modified Congo red agar (MCRA) and Microtiter plate methods to assess the ability of biofilm formation. All isolates were examined for determination of biofilm related genes, icaA, fnbA, clfA and bap using PCR method.

Results: Linezolid, quinupristin/dalfopristin and chloramphenicol were the most effective agents against S. aureus isolates. Overall, 69.2% of S. aureus isolates were biofilm producers. Resistance to four antibiotics such as nitrofurantoin (71.4% vs. 28.6%, P=0.001), tetracycline (57.7% vs. 42.3%, P=0.028), erythromycin and ciprofloxacin (56% vs. 44%, P=0.017) was higher among biofilm producers than non-biofilm producers. The icaA, fnbA and clfA genes were present in all S. aureus isolates. However, bap gene was not detected in any of the isolates.

Conclusion: Our findings reinforce the role of biofilm formation in resistance to antimicrobial agents. Trimethoprim-sulfamethoxazole and doxycycline may be used as an effective treatment for UTI caused by biofilm producers S. aureus. Our results suggest that biofilm formation is not dependent to just icaA, fnbA, clfA and bap genes harbor in S. aureus strains.



Ranjbar R, Haghi-Ashtiani M, Jafari NJ, Abedini M (2009). The prevalence and antimicrobial susceptibility of bacterial uropathogens isolated from pediatric patients. Iran J Public Health, 38 (2): 134-38.

Mobaleghi J, Salimizand H, Beiranvand S, Membari Sh, Kalantar E (2012). Extended spectrum beta-lactamases in urinary isolates of Escherichia coli in five Iranian hospitals. Int J Infect Dis, 5: 35-6.

Taheri PA, Navabi B, Khatibi E (2013). Frequency and susceptibility of bacteria caused urinary tract infection in neonates: eight-year study at neonatal division of bahrami children’s hospital, Tehran Iran. Iran J Public Health, 42 (10): 1126-33.

Kayas L, Yolbas I, Ece A, Kayas Y, Kocamaz H (2011). Causative agents and antibiotic susceptibilities in children with urinary tract infection. J Microbiol Infect Dis, 1 (101): 17-21.

Tayebi Z, Seyedjavadi SS, Goudarzi M, Rahimi MK, Boromandi S, Bostanabad SZ (2014). Frequency and antibiotic resistance pattern in gram positive uropathogenes isolated from hospitalized patients with urinary tract infection in Tehran, Iran. J Genes Microb Immun, 1-9.

Vasudevan R (2015). Emergence of UTI causing Staphylococcus aureus as a superbug: has the pathogen reduced the options of antimicrobial agents for treatment? EC Microbiol, 1: 88-112.

Havaei SA, Ohadian Moghadam S, Pour-mand MR, Faghri J (2010). Prevalence of genes en¬coding bi-component leuko-cidins among clin¬ical isolates of methicil-lin–resistant Staphylococ¬cus aureus. Iran J Pub-lic Health, 39 (1): 8-14.

Choong S, Whitfield H (2000). Biofilms and their role in infections in urology. BJU Int, 86 (8): 935-41.

Reiter KC, Paim TGS, Oliveira CF, d'Azevedo PA (2011). High biofilm production by invasive multiresistant staphylococci. Apmis, 119 (11): 776-81.

Ohadian Moghadam S, Pourmand MR, Aminharati F (2014). Biofilm formation and antimicrobial resistance in methicillin-resistant Staphylococcus aureus isolated from burn patients, Iran. J Infect Dev Ctries, 8 (12): 1511-17.

Niveditha S, Pramodhini S, Umadevi S, KUMar S, StePheN S (2012). The isolation and the biofilm formation of uropathogens in the patients with catheter associated urinary tract infections (UTIs). J Clin Diagn Res, 6 (9): 1478-82.

Ando E, Monden K, Mitsuhata R, Kariyama R, Kumon H (2004). Biofilm formation among methicillin-resistant Staphylococcus aureus isolates from patients with urinary tract infection. Acta Med Okayama, 58 (4): 207-14.

Soto SM (2014). Importance of biofilms in urinary tract infections: new therapeutic approaches. Adv Biol, 543974.

Kaur DC, Wankhede S (2014). Biofilm formation and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus from wound infection. Asian Pac J Health Sci, 1 (4): 322-28.

Tang J, Chen J, Li H, Zeng P, Li J (2013). Characterization of adhesin genes, staphylococcal nuclease, hemolysis, and biofilm formation among Staphylococcus aureus strains isolated from different sources. Foodborne Pathog Dis, 10 (9): 757-63.

Eyoh AB, Toukam M, Atashili J, Fokunang C, Gonsu H, Lyonga EE (2014). Relationship between multiple drug resistance and biofilm formation in Staphylococcus aureus isolated from medical and non-medical personnel in Yaounde, Cameroon. Pan Afr Med J, 17: 186.

Wayne P (2014). Clinical and laboratory standards institute. Performance standards for antimicrobial susceptibility testing. 24th Inform Suppl 34 (1): M100-S24.

Arciola CR, Campoccia D, Gamberini S, Cervellati M, Donati E, Montanaro L (2002). Detection of slime production by means of an optimised Congo red agar plate test based on a colourimetric scale in Staphylococcus epidermidis clinical isolates genotyped for ica locus. Biomaterials, 23 (21): 4233-39.

Mirzaee M, Najar Peerayeh S, Ghasemian AM (2014). Detection of icaABCD genes and biofilm formation in clinical isolates of methicillin resistant Staphylococcus aureus. Iran J Pathol, 9 (4): 257-62.

Tangchaisuriya U, Yotpanya W, Kitti T, Sitthisak S (2014). Distribution among Thai children of methicillin-resistant Staphylococcus aureus lacking cna, fnbA and icaAD. Southeast Asian J Trop Med Public Health, 45 (1): 149-56.

Nemati M, Hermans K, Devriese LA, Maes D, Haesebrouck F (2009). Screening of genes encoding adhesion factors and biofilm formation in Staphylococcus aureus isolates from poultry. Avian Pathol, 38 (6): 513-17.

Pourmand MR, Memarian M, Hoseini M, Yazdchi SB (2009). High prevalence of sea gene among clinical isolates of Staphylococcus aureus in Tehran. Acta Med Iran, 47 (5): 357-61.

Pourmand MR, Yousefi M, Salami SA, Amini M (2014). Evaluation of expression of NorA efflux pump in ciprofloxacin resistant Staphylococcus aureus against hexahydroquinoline derivative by Real-Time PCR. Acta Med Iran, 52 (6): 424-429.

Poorabbas B, Mardaneh J, Rezaei Z, Kalani M, Pouladfar G, Alami MH, et al (2015). Nosocomial infections: multicenter surveillance of antimicrobial resistance profile of Staphylococcus aureus and Gram negative rods isolated from blood and other sterile body fluids in Iran. Iran J Microbiol, 7 (3): 127-35.

Taiwo S, Aderounmu A (2006). Catheter associated urinary tract infection: aetiologic agents and antimicrobial susceptibility pattern in Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria. Afr J Biomed Res, 9 (3): 141-48.

Castelani L, Pilon LE, Martins T, Pozzi CR, Arcaro JRP (2015). Investigation of biofilm production and icaA and icaD genes in Staphylococcus aureus isolated from heifers and cows with mastitis. Anim Sci J, 86 (6): 340-44.

Bekir K, Haddad O, Grissa M, Chaieb K, Bakhrouf A, Elgarssdi SI (2012). Molecular detection of adhesins genes and biofilm formation in methicillin resistant Staphylococcus aureus. Afr J Microbiol Res, 6 (23): 4908-17.

Cucarella C, Solano C, Valle J, Amorena B, Lasa I, Penades JR (2001). Bap, a Staphylococcus aureus surface protein involved in biofilm formation. J Bacteriol, 183 (9): 2888-96.

Szweda P, Schielmann M, Milewski S, Frankowska A, Jakubczak A (2012). Biofilm production and presence of ica and bap genes in Staphylococcus aureus strains isolated from cows with mastitis in the eastern Poland. Pol J Microbiol, 61 (1): 65-9.

Cramton SE, Gerke C, Schnell NF, Nichols WW, Gotz F (1999). The intercellular adhesion (ica) locus is present in Staphylococcus aureus and is required for biofilm formation. Infect Immun, 67 (10): 5427-33.

IssueVol 45 No 4 (2016) QRcode
SectionOriginal Article(s)
Urinary tract infection Staphylococcus aureus Biofilm formation Antibiotic resistance

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
YOUSEFI M, POURMAND MR, FALLAH F, HASHEMI A, MASHHADI R, NAZARI-ALAM A. Characterization of Staphylococcus aureus Biofilm Formation in Urinary Tract Infection. Iran J Public Health. 2016;45(4):485-493.