Acta Scientific Clinical Case Reports

Case ReportVolume 4 Issue 2

The Prevalence of Biofilm Formers Among Clinical Isolates of Klebsiella pneumoniae: A Meta-Analysis

Mohammed Afzal*

Independent Researcher, Sweden

*Corresponding Author: Mohammed Afzal, Independent Researcher, Sweden.

Received: December 13, 2022; Published: January 10, 2023


Background: The study explored the prevalence of biofilm formers in Klebsiella Pneumonia, a gram-negative bacterium that has high propensity to form antibiotic resistant strains and forms biofilms. Biofilms are complex microbial community with attributes that vary from planktonic cells.

Methods: A single-armed meta-analysis was done to assess prevalence of biofilm formers. Published studies were reviewed from PubMed and Scopus. A random effects meta-analysis was done. Freeman-Tuckey double arcsine method was selected for transformation. Publication bias was assessed using Doi plot and Luis Furuya-Kanamori (LFK) index.

Results: 23 studies were selected for the review. The meta-analysis revealed 74% (95% CI: 64%-83%) prevalence of biofilm formers among clinical isolates of Klebsiella pneumonia. The indices of heterogeneity among the included studies was high, indicated by a p value <0.01 and I2 = 94.4%. Doi plot showed asymmetry marked by unequal deviation and lengths of the arms. The LFK index of -0.67.

Conclusions: The prevalence rate is comparable with that of prevalence rate attained by other bacterium by similar meta-analysis studies. This high prevalence of biofilm formers warrants for a paradigm shift in treatment strategies for treatment of infections.

Keywords: Biofilm; K. Pneumonia; Meta-analysis


  1. Costerton J W., et al. “Microbial Biofilms”. Annual Review of Microbiology1 (1995): 711-745.
  2. Yang L., et al. “Current understanding of multi-species biofilms”. International Journal of Oral Science 3 (2011): 74-81.
  3. Blaser J., et al. “In vivo verification of in vitro model of antibiotic treatment of device-related infection”. Antimicrobial Agents and Chemotherapy5 (1995): 1134-1139.
  4. Deretic V., et al. “MINIREVIEW Conversion of Pseudomonas aeruginosa to Mucoidy in Cystic Fibrosis: Environmental Stress and Regulation of Bacterial Virulence by Alternative Sigma Factors”. In Journal of Bacteriology 176.10 (1995).
  5. Rayner M G., et al. “Evidence of Bacterial Metabolic Activity in Culture-Negative Otitis Media With Effusion”. Clinical Investigation 279 (1998).
  6. Sanchez CJ., et al. “Biofilm formation by clinical isolates and the implications in chronic infections”. BMC Infectious Diseases 13 (2013): 47.
  7. Hall CW and Mah TF. “Molecular mechanisms of biofilm-based antibiotic resistance and tolerance in pathogenic bacteria”. FEMS Microbiology Reviews 010 (2017): 276-301.
  8. Stewart PS. “Mechanisms of antibiotic resistance in bacterial biofilms”. In International Journal of Medical Microbiology (2002): 292.
  9. Christensen G D., et al. “Adherence of slime-producing strains of Staphylococcus epidermidis to smooth surfaces”. Infection and Immunity1 (1982): 318-326.
  10. Christensen G D., et al. “Adherence of coagulase-negative staphylococci to plastic tissue culture plates: a quantitative model for the adherence of staphylococci to medical devices”. Journal of Clinical Microbiology6 (1985): 996-1006.
  11. Freeman D J., et al. “New method for detecting slime production by coagulase negative staphylococci”. Journal of Clinical Pathology8 (1989): 872-874.
  12. Hochbaum A., et al. “Confocal Laser Scanning Microscopy for Analysis of Pseudomonas aeruginosa Biofilm Architecture and Matrix Localization” 10 (2019): 677.
  13. LeChevallier M W., et al. “Factors promoting survival of bacteria in chlorinated water supplies”. Applied and Environmental Microbiology 3 (1988): 649-654.
  14. Clegg S and Murphy CN. “Epidemiology and Virulence of Klebsiella pneumoniae”. Microbiology Spectrum1 (2016).
  15. Boddicker JD., et al. “Signature-Tagged Mutagenesis of Klebsiella pneumoniae To Identify Genes That Influence Biofilm Formation on Extracellular Matrix Material”. Infection and Immunity 8 (2006): 4590-4597.
  16. Chen L., et al. “Investigation of LuxS-mediated quorum sensing in Klebsiella pneumoniae”. Journal of Medical Microbiology 3 (2020): 402-413.
  17. Wu MC., et al. “Cellobiose-Specific Phosphotransferase System of Klebsiella pneumoniae and Its Importance in Biofilm Formation and Virulence”. Infection and Immunity7 (2012): 2464-2472.
  18. Hassan A., et al. “Evaluation of different detection methods of biofilm formation in the clinical isolates”. The Brazilian Journal of Infectious Diseases4 (2011): 305-311.
  19. Garousi M., et al. “A global systematic review and meta-analysis on correlation between biofilm producers and non-biofilm producers with antibiotic resistance in Uropathogenic Escherichia coli”. Microbial Pathogenesis 164 (2022): 105412.
  20. Hadadi-Fishani M., et al. “Correlation between biofilm formation and antibiotic resistance in Pseudomonas aeruginosa: a meta-analysis”. Le Infezioni in Medicina1 (2020): 47-54.
  21. Karballaei Mirzahosseini H., et al. “Meta-Analysis of Biofilm Formation, Antibiotic Resistance Pattern, and Biofilm-Related Genes in Pseudomonas aeruginosa Isolated from Clinical Samples”. Microbial Drug Resistance 7 (2020): 815-824.
  22. Coli E., et al. “Global gene expression in Escherichia coli biofilms”. In Molecular Microbiology 48.1 (2003).

Citation: Mohammed Afzal. “The Prevalence of Biofilm Formers Among Clinical Isolates of Klebsiella pneumoniae: A Meta-Analysis". Acta Scientific Clinical Case Reports 4.2 (2023): 20-24.

Copyright: © 2022 Mohammed Afzal. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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