ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
Ciprofloxacin resistance enhances biofilm formation and modulates virulence in Acinetobacter baumannii: Insights into the role of efflux pumps and quorum sensing.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Acinetobacter baumannii is a critical priority pathogen due to its capacity to develop resistance to last-resort antibiotics and to form persistent biofilms. Both contribute to treatment failure. This study investigated co-regulatory mechanisms of ciprofloxacin resistance and biofilm formation in A. baumannii ATCC 19606. Stepwise antibiotic exposure yielded a ciprofloxacin-resistant isogenic strain (CipR), with a minimum inhibitory concentration (MIC) of 128 µg/mL. CipR exhibited significantly enhanced biofilm formation compared to the susceptible strain (P ≤ 0.0001), with a strong positive correlation (Rs = 0.9818) between MIC values and biofilm biomass. Minimum biofilm eradication concentrations (MBEC) increased markedly in the CipR strain. Whole-genome sequencing identified CipR-mutations in gyrB (DNA gyrase subunit B), a multidrug efflux transporter, and a hypothetical protein. Transcriptomic analyses revealed overexpression of the quorum sensing (QS) system AbaI/AbaR in CipR biofilm cells. Inhibition of QS with sub-inhibitory streptomycin concentrations reduced biofilm formation without altering ciprofloxacin MIC, suggesting the existence of other co-regulatory pathways. Efflux pump inhibition with CCCP did not impact either biofilm biomass or resistance levels. Ciprofloxacin resistance acquisition incurred a metabolic cost, evidenced by XTT assays and reduced bacterial growth. Resistance downregulated the expression of adhesion-related genes and diminished functional adhesion/invasion of human lung epithelial cells. Overall, the findings suggest that ciprofloxacin resistance, biofilm formation, and virulence may be co-regulated in A. baumannii, possibly through QS and other yet-to-be-identified regulatory networks. These results provide novel insights into the adaptive mechanisms of A. baumannii and highlight potential targets for therapeutic intervention.
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