Biofilm is a major virulence determinant in bacterial colonization of chronic skin ulcers independently from the multidrug resistant phenotype

Enea Gino Di Domenico, Ilaria Farulla, Grazia Prignano, Maria Teresa Gallo, Matteo Vespaziani, Ilaria Cavallo, Isabella Sperduti, Martina Pontone, Valentina Bordignon, Laura Cilli, Alessandra De Santis, Fabiola Di Salvo, Fulvia Pimpinelli, Ilaria Lesnoni La Parola, Luigi Toma, Fabrizio Ensoli

Research output: Contribution to journalArticlepeer-review


Bacterial biofilm is a major factor in delayed wound healing and high levels of biofilm production have been repeatedly described in multidrug resistant organisms (MDROs). Nevertheless, a quantitative correlation between biofilm production and the profile of antimicrobial drug resistance in delayed wound healing remains to be determined. Microbial identification, antibiotic susceptibility and biofilm production were assessed in 135 clinical isolates from 87 patients. Gram-negative bacteria were the most represented microorganisms (60.8%) with MDROs accounting for 31.8% of the total isolates. Assessment of biofilm production revealed that 80% of the strains were able to form biofilm. A comparable level of biofilm production was found with both MDRO and not-MDRO with no significant differences between groups. All the methicillin-resistant Staphylococcus aureus (MRSA) and 80% of Pseudomonas aeruginosa MDR strains were found as moderate/high biofilm producers. Conversely, less than 17% of Klebsiella pneumoniae extended-spectrum beta-lactamase (ESBL), Escherichia coli-ESBL and Acinetobacter baumannii were moderate/high biofilm producers. Notably, those strains classified as non-biofilm producers, were always associated with biofilm producer bacteria in polymicrobial colonization. This study shows that biofilm producers were present in all chronic skin ulcers, suggesting that biofilm represents a key virulence determinant in promoting bacterial persistence and chronicity of ulcerative lesions independently from the MDRO phenotype.

Original languageEnglish
Article number1077
JournalInternational Journal of Molecular Sciences
Issue number5
Publication statusPublished - May 17 2017


  • Acinetobacter baumannii
  • Biofilm
  • ESBL
  • Escherichia coli
  • Klebsiella pneumoniae
  • MDRO
  • MRSA
  • Pseudomonas aeruginosa
  • Skin ulcer
  • Wound

ASJC Scopus subject areas

  • Catalysis
  • Molecular Biology
  • Spectroscopy
  • Computer Science Applications
  • Physical and Theoretical Chemistry
  • Organic Chemistry
  • Inorganic Chemistry


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