Comparative analysis of biofilm detection methods and antibiotic resistance in catheter-associated uropathogens: a cross-sectional study from Syria.

Catheter-associated urinary tract infections (CAUTIs) are a major healthcare challenge due to bacterial biofilm formation, which protects pathogens from antibiotics and host immune responses. Three phenotypic biofilm detection methods-Microplate assay, Tube Method, and Modified Congo Red Agar (MCRA)- were compared using bacterial isolates from catheter tips and urine samples. The Microplate assay, considered the reference standard, detected biofilm in 88.6% of catheter isolates and 78.6% of urine isolates. Notably, 44% of urine samples showed no microbial growth, likely due to prior antibiotic use. In catheter-derived samples, CRA showed higher sensitivity (81.8%) and specificity (61.5%) than the Tube method (72.7% and 46.2%, respectively). PPV and NPV were 87.0% and 46.2% for CRA, and 82.2% and 22.7% for Tube. Both methods performed less reliably in urine isolates. Strong biofilm formation was more prevalent in catheter isolates (62.5%) than in urine isolates (44.6%) and was associated with higher antimicrobial resistance. Gentamicin was most effective against urine isolates (85.7%), whereas Imipenem showed highest efficacy in catheter isolates (47.7%). These findings provide practical guidance for microbiology laboratories, especially in low-resource settings, by identifying reliable phenotypic methods for biofilm screening. Overall, sensitive biofilm detection combined with targeted antibiotic susceptibility testing is crucial for effective CAUTI management and antimicrobial stewardship.