The emergence and spread of antibiotic resistance, as well as the evolution of new strains of disease causing agents, are of great concern to the global health community. Effective treatment of a disease entails the development of new pharmaceuticals or some potential source of novel drugs. Commonly used medicinal plants of our community could be an excellent source of drugs to fight off this problem. This study is focused on exploring the antimicrobial properties of the plants that are commonly being used as traditional medicines. The antimicrobial potential of four different plant extracts was screened against twelve pathogenic microorganisms and two reference bacterial strains. Methanolic extracts of Oxalis corniculata, Artemisia vulgaris, Cinnamomum tamala, and Ageratina adenophora were subjected to a test of their antimicrobial properties by agar well diffusion method. The result indicated that most of the extracts exhibited antimicrobial properties. The highest potential was observed in the extract of O. corniculata against Escherichia coli, Salmonella Typhi, MDR Salmonella Typhi, Klebsiella pneumoniae, and Citrobacter koseri with zone of inhibition (ZOI) of 17 mm, 13 mm, 16 mm, 11 mm, and 12 mm, respectively. Oxalis corniculata also showed the highest MIC against test organisms. The methanolic extract of Artemisia vulgaris, Cinnamomum tamala, and Ageratina adenophora showed efficacy against Staphylococcus aureus. Ageratina adenophora also showed antifungal activity against Rhizopus spp. The experiment confirmed the efficacy of some selected plant extracts as natural antimicrobials and suggested the possibility of employing them in drugs for the treatment of infectious diseases caused by the test organisms.

Staphylococcus aureus, a notorious human pathogen, is a major cause of the community as well as healthcare associated infections. It can cause a diversity of recalcitrant infections mainly due to the acquisition of resistance to multiple drugs, its diverse range of virulence factors, and the ability to produce biofilm in indwelling medical devices. Such biofilm associated chronic infections often lead to increase in morbidity and mortality posing a high socio-economic burden, especially in developing countries. Since biofilm formation and antibiotic resistance function dependent on each other, detection of biofilm expression in clinical isolates would be advantageous in treatment decision. In this premise, we attempt to investigate the biofilm formation and its association with antibiotic resistance in clinical isolates from the patients visiting tertiary health care hospitals in Nepal. Bacterial cells isolated from clinical samples identified as S. aureus were examined for in-vitro biofilm production using both phenotypic and genotypic assays. The S. aureus isolates were also examined for susceptibility patterns of clinically relevant antibiotics as well as inducible clindamycin resistance using standard microbiological techniques and D-test, respectively. Among 161 S. aureus isolates, 131 (81.4%) were methicillin resistant S. aureus (MRSA) and 30 (18.6%) were methicillin sensitive S. aureus (MSSA) strains. Although a majority of MRSA strains (69.6%) showed inducible clindamycin resistance, almost all isolates (97% and 94%) were sensitive toward chloramphenicol and tetracycline, respectively. Detection of in vitro production of biofilm revealed the association of biofilm with methicillin as well as inducible clindamycin resistance among the clinical S. aureus isolates.

Staphylococcus genus comprising both Staphylococcus aureus and coagulase negative staphylococci (CoNS) are widely distributed in nature and can infect diversity of hosts. Indeed, staphylococci are the major pathogens causing biofilm associated infections caused by contaminated hospital indwelling devices. These infections are persistent in nature being highly refractory to various stresses including antibiotics. Implementation of efficient diagnostic techniques for the biofilm production would help minimize the disease burden. Thus, early detection of pathogenic strains producing biofilms warrant the utmost importance in diagnostic laboratories especially in resource limited settings. Among 375 isolates collected from different clinical specimens, 214 (57%) were identified as coagulase negative staphylococci and 161 (43%) S. aureus. Detection of In-vitro biofilm formation in these isolates were carried out by three commonly used phenotypic assays and a genotypic assay. While evaluating the results, tissue-culture method with supplemented glucose and sucrose showed the best correlation with the results of genotypic assay.

Background: Coagulase-negative staphylococci (CNS) survive as commensals of skin, anterior nares and external canals of human and were regarded as non-infectious pathogens. However, they are emerging as a major cause of nosocomial infectious due to their ability to form biofilms and high resistance to several classes of antibiotics. This study examines the biofilm forming abilities of 214 clinical CNS isolates using phenotypic and genotypic methods, and determines their antibiotic susceptibility patterns. Methods: A total of 214 clinical isolates collected from different clinical samples were identified as CNS and their antibiotic susceptibility determined by CLSI guidelines. The biofilm forming ability of all isolates was determined by three phenotypic methods; Congo red agar (CRA) method, tube adherence method (TM) and tissue culture plate (TCP) method and by genotypic method for the detection of icaAD genes. Results: Among all the isolates, S. epidermidis (57.5%) was found the most frequently, followed by S. saprophyticus (18.7%), S. haemolyticus (11.2%), S. hominis (7%), and S. capitis (5.6%). Antibiotic susceptibility pattern demonstrated 91.6% isolates were resistant to penicillin and 66.8% to cefoxitin while 91.1% isolates were susceptible to chloramphenicol. Constitutive and inducible clindamycin resistant phenotype as measured by D-test was seen among 28% and 14.5% of isolates respectively. Tissue culture plate method detected biofilm production in 42.1% isolate followed by 31.8% through tube method while 20.1% isolates were found to produce slime in Congo red agar method. The genotypic assay revealed presence of icaA and icaD genes in 19.2% isolates. Conclusion: The study shows a high prevalence of biofilm formation and inducible clindamycin resistance in CNS isolates, indicating the importance of in-vitro biofilm production test and D-test in routine laboratory diagnostics. Implementation of efficient diagnostic techniques for detection of biofilm production in clinical samples can help manage staphylococcal infections and minimize risks of treatment failures in hospitals.

Background: Staphylococcus aureus is a notorious human pathogen that causes often lethal systemic conditions that are mostly medical device associated biofilm infections. Similarly, coagulase negative staphylococci are emerging as leading pathogen for nosocomial infections owing to their ability to form biofilm on implanted medical equipment. Chronic in nature, these infections are difficult to treat. Such recalcitrance of these infections is caused mainly due to the presence of persister cells, which exhibit transient yet extreme tolerance to antibiotics. Despite tremendous clinical significance, there is lack of studies on persister cells formation among clinical bacterial isolates. Considering the importance of factors influencing persister formation, in this study, we evaluate the association of antibiotic tolerance with biofilm production, antibiotic stress, growth phase, specimen type, and dependency on staphylococcal species. Biofilm formation was detected among 375 clinical staphylococcal isolates by quantitative tissue culture plate method (TCP) and icaAD genes by genotypic method. The antibiotic susceptibility was determined by Kirby Bauer disc diffusion method while minimum inhibitory concentration values were obtained by agar dilution method. Persister cells were measured in the susceptible staphylococcal isolates in the presence of clinically relevant antibiotics. Results: In the study, 161 (43%) S. aureus and 214 (57%) coagulase negative staphylococci (CNS) were isolated from different clinical samples. TCP method detected biofilm production in 84 (52.2%) S. aureus and 90 (42.1%) CNS isolates. The genotypic method detected icaAD genes in 86 (22.9%) isolates. Majority (> 90%) of both the biofilm producers and non-producers were sensitive to chloramphenicol and tetracycline but were resistant to penicillin. Interestingly, all isolates were sensitive to vancomycin irrespective of biofilm production. While high persister frequency was observed among all staphylococci isolates in the stationary growth phase, the persister frequency in exponential growth phase was statistically high among isolates possessing icaAD genes compared to icaAD negative isolates. Conclusion: The research findings provide strong evidence that the clinical staphylococcal isolates exhibit extreme antibiotic tolerance suggesting their causal link with treatment failures. Understanding the factors influencing the formation and maintenance of persister cells are of utmost important aspect to design therapeutics and control recalcitrant bacterial infections.

Methicillin resistant Staphylococcus aureus (MRSA) is a human pathogen that can cause hospital and community acquired infections. Biofilm formation is a major virulence factor contributing to its pathogenicity. This study aimed to detect biofilm formation ability among methicillin resistant Staphylococcus aureus (MRSA) clinical isolates and determine SCCmec types. A total of 115 S. aureus were isolated from various clinical samples collected at Nepal Armed Police Hospital from August 2022 to February 2023. The antibiotic susceptibility test was performed via a modified Kirby Bauer disc diffusion method following CLSI guidelines. Phenotypic detection of biofilm formation was performed by microtiter plate assay. Polymerase chain reaction was performed to detect mecA, icaA and SCCmec types. More than 90% of the isolates were resistant to cefixime and penicillin. Among the total isolates, 66% were multidrug resistant. The disc diffusion method detected 60% of the isolates as MRSA, with 15 isolates lacking the mecA gene. Different levels of biofilm biomass were observed among 86 (75%) of the isolates by microtiter plate method. PCR revealed the presence of the icaA gene in a low number of the isolates (16%). Compared with biofilm nonproducer isolates, biofilm producing S. aureus isolates presented a greater incidence of antibiotic resistance with multi drug resistance (MDR). SCCmec type V (21%) predominated, followed by type II (13%) and most of them were MDR and biofilm producers. Our results indicate a relatively high incidence of community acquired S. aureus circulating in the hospital setting. This study is the first to explore the associations between SCCmec types and biofilm formation among clinical isolates in Nepal. Monitoring the prevalence of biofilm producing S. aureus provides valuable insights into the evolving epidemiology of healthcare associated infections, facilitating the development of targeted infection control strategies.