{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T21:30:36Z","timestamp":1791927036969,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,5,29]],"date-time":"2021-05-29T00:00:00Z","timestamp":1622246400000},"content-version":"vor","delay-in-days":148,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Nepal Health Research Council through Undergraduate Health Research Grant","award":["1583"],"award-info":[{"award-number":["1583"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BioMed Research International"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p><jats:italic>Background<\/jats:italic>. Emerging threat of drug resistance among pathogens causing ventilator\u2010associated pneumonia (VAP) has resulted in higher hospital costs, longer hospital stays, and increased hospital mortality. Biofilms in the endotracheal tube of ventilated patients act as protective shield from host immunity. They induce chronic and recurrent infections that defy common antibiotics. This study intended to determine the biofilm produced by pathogens causing VAP and their relation with drug resistance. <jats:italic>Methods<\/jats:italic>. Bronchoalveolar lavage and deep tracheal aspirates (<jats:italic>n<\/jats:italic> = 70) were obtained from the patients mechanically ventilated for more than 48 hours in the intensive care units of Tribhuvan University Teaching Hospital, Kathmandu, and processed according to the protocol of the American Society for Microbiology (ASM). Antibiotic susceptibility testing was done following Clinical and Laboratory Standards Institute (CLSI) 2017 guidelines. Biofilm formation was determined using the microtiter plate method described by Christensen and modified by Stepanovoic et al. <jats:italic>Results<\/jats:italic>. Significant microbial growth was seen in 78.6% of the total samples with 52.7% monomicrobial, 45.5% polymicrobial, and 1.8% fungal infection. Among the 71 isolates obtained, bulk was gram\u2010negative (<jats:italic>n<\/jats:italic> = 64, 90.1%). <jats:italic>Pseudomonas aeruginosa<\/jats:italic> (31.0%) was the predominant isolate followed by <jats:italic>Acinetobacter calcoaceticus baumannii<\/jats:italic> complex (16.9%), <jats:italic>Klebsiella pneumoniae<\/jats:italic> (16.9%), <jats:italic>Citrobacter freundii<\/jats:italic> (15.5%), <jats:italic>Staphylococcus aureus<\/jats:italic> (7.0%), <jats:italic>Escherichia coli<\/jats:italic> (5.6%), <jats:italic>Citrobacter koseri<\/jats:italic> (2.8%), <jats:italic>Enterococcus faecalis<\/jats:italic> (1.4%), <jats:italic>Burkholderia cepacia<\/jats:italic> complex (1.4%), and <jats:italic>Candida albicans<\/jats:italic> (1.4%). Of the total isolates, 56.3% were biofilm producers. Multidrug\u2010resistant (MDR) organisms, extended\u2010spectrum <jats:italic>\u03b2<\/jats:italic>\u2010lactamase (ESBL), and metallo\u2010<jats:italic>\u03b2<\/jats:italic>\u2010lactamase (MBL) producers were preeminent among the biofilm producers. The highest producer of biofilm was <jats:italic>P. aeruginosa<\/jats:italic> (19.7%). Among gram\u2010negative biofilm producers, 42.2% were MDR, 21.9% were ESBL producers, and 7.8% were MBL producers. <jats:italic>Conclusion.<\/jats:italic> Gram\u2010negative nonfermenter bacteria account for the bulk of nosocomial pneumonia. MDR, ESBL, and MBL production was preponderant among the biofilm producers. The rampant spread of drug resistance among biofilm producers is summoning novel interventions to combat multidrug resistance.<\/jats:p>","DOI":"10.1155\/2021\/8817700","type":"journal-article","created":{"date-parts":[[2021,5,29]],"date-time":"2021-05-29T17:35:13Z","timestamp":1622309713000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Biofilm Formation by Pathogens Causing Ventilator\u2010Associated Pneumonia at Intensive Care Units in a Tertiary Care Hospital: An Armor for Refuge"],"prefix":"10.1155","volume":"2021","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3180-7459","authenticated-orcid":false,"given":"Sujata","family":"Baidya","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangita","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3888-7319","authenticated-orcid":false,"given":"Shyam Kumar","family":"Mishra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hari Prasad","family":"Kattel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keshab","family":"Parajuli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeevan Bahadur","family":"Sherchand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,29]]},"reference":[{"key":"e_1_2_9_1_2","volume-title":"Prevention of Hospital Acquired Infections: A Practical Guide","author":"Ducel G.","year":"2002"},{"key":"e_1_2_9_2_2","first-page":"714","article-title":"What is ventilator-associated pneumonia and why is it important?","volume":"50","author":"Kollef M. H.","year":"2005","journal-title":"Respiratory Care"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200405-644ST"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc13775"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/847569"},{"key":"e_1_2_9_6_2","first-page":"46","article-title":"Bacterial biofilm in ventilator-associated pneumonia: a clinical concern","volume":"6","author":"Shahrokhi E.","year":"2018","journal-title":"Journal of Research in Medical and Dental Science"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0247832"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy543"},{"key":"e_1_2_9_9_2","article-title":"Ventilator associated pneumonia in tertiary care hospital, Maharajgunj, Kathmandu, Nepal","volume":"35","author":"Shrestha R. K.","year":"2013","journal-title":"Journal of Institute of Medicine Nepal"},{"key":"e_1_2_9_10_2","doi-asserted-by":"publisher","DOI":"10.31729\/jnma.3216"},{"key":"e_1_2_9_11_2","article-title":"Prevalence of ventilator associated pneumonia in neonates in a tertiary care hospital in western Nepal","volume":"57","author":"Lamichhane A.","year":"2019","journal-title":"Journal of Nepal Medical Association"},{"key":"e_1_2_9_12_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid0809.020063"},{"key":"e_1_2_9_13_2","doi-asserted-by":"publisher","DOI":"10.1128\/cmr.15.2.167-193.2002"},{"key":"e_1_2_9_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc11357"},{"key":"e_1_2_9_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0966-842x(00)01913-2"},{"key":"e_1_2_9_16_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.284.5418.1318"},{"key":"e_1_2_9_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0065-2911(02)46005-5"},{"key":"e_1_2_9_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e3325"},{"key":"e_1_2_9_19_2","volume-title":"Clinical Microbiology Procedures Handbook","author":"Isenberg H. D.","year":"2004"},{"key":"e_1_2_9_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0167-7012(00)00122-6"},{"key":"e_1_2_9_21_2","volume-title":"Performance Standards for Antimicrobial Susceptibility Testing","author":"CLSI","year":"2017"},{"key":"e_1_2_9_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkq210"},{"key":"e_1_2_9_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199905000-00020"},{"key":"e_1_2_9_24_2","doi-asserted-by":"publisher","DOI":"10.3126\/ijim.v1i1.6639"},{"key":"e_1_2_9_25_2","article-title":"Nosocomial bacterial infection and antimicrobial resistant pattern in a tertiary care hospital in Nepal","volume":"36","author":"Sah M. K.","year":"2014","journal-title":"Journal of Institute of Medicine"},{"key":"e_1_2_9_26_2","doi-asserted-by":"publisher","DOI":"10.3126\/jiom.v41i2.26549"},{"key":"e_1_2_9_27_2","first-page":"1","article-title":"Biofilm producing multidrug and extensive drug resistant bacterial pathogens from tracheal aspirates of intensive care unit patients-a threat to combat","volume":"1","author":"Gupta R.","year":"2015","journal-title":"International Journal of Current Microbiology and Applied Sciences"},{"key":"e_1_2_9_28_2","first-page":"15","article-title":"Assessment of biofilm formation by the causative organism of ventilator associated pneumonia at intensive care unit of a tertiary care hospital","volume":"2","author":"Mulla S. A.","year":"2012","journal-title":"The National Journal of Emergency Research"},{"key":"e_1_2_9_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00284-014-0694-5"},{"key":"e_1_2_9_30_2","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2018.0027"},{"key":"e_1_2_9_31_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-019-4084-8"},{"key":"e_1_2_9_32_2","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.165.7.2105078"},{"key":"e_1_2_9_33_2","doi-asserted-by":"publisher","DOI":"10.3126\/tujm.v5i0.22313"},{"key":"e_1_2_9_34_2","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2014.17.186.2363"},{"key":"e_1_2_9_35_2","first-page":"366","article-title":"Is there correlation of biofilm formation with multidrug resistance and ESBL production in Pseudomonas aeruginosa?","volume":"4","author":"Neopane P.","year":"2017","journal-title":"European Journal of Biomedical"},{"key":"e_1_2_9_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.micpath.2017.04.039"},{"key":"e_1_2_9_37_2","doi-asserted-by":"publisher","DOI":"10.12980\/apjtd.7.2017D7-15"},{"key":"e_1_2_9_38_2","doi-asserted-by":"publisher","DOI":"10.3126\/nmcj.v21i2.25109"},{"key":"e_1_2_9_39_2","first-page":"65","article-title":"Incidence of biofilm formation in ET tube and correlation with occurrence of VAP in a tertiary care ICU","volume":"7","author":"Uppe A.","year":"2019","journal-title":"American Journal of Infectious Diseases"},{"key":"e_1_2_9_40_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-017-0222-z"},{"key":"e_1_2_9_41_2","doi-asserted-by":"publisher","DOI":"10.1021\/acsomega.9b04178"}],"container-title":["BioMed Research International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/bmri\/2021\/8817700.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/bmri\/2021\/8817700.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/2021\/8817700","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T07:17:09Z","timestamp":1735629429000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/2021\/8817700"}},"subtitle":[],"editor":[{"given":"Stanley","family":"Brul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":41,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1155\/2021\/8817700"],"URL":"https:\/\/doi.org\/10.1155\/2021\/8817700","archive":["Portico"],"relation":{},"ISSN":["2314-6133","2314-6141"],"issn-type":[{"value":"2314-6133","type":"print"},{"value":"2314-6141","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1]]},"assertion":[{"value":"2020-09-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"8817700"}}