Assalam. Good morning audiences, thank you for coming today.

First, i want to thank you for the opportunity to speak here

And let me introduce my self,
My name is Mohamad yanuar prasetyo nugroho, Im a medical student from ukrida
jakarta.
Today, The topic i want to talk about, is detection of biofilm formation from
enterococcus faecalis of urine catheters using congo red agar and tissue culture plate
Lets begin.
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Some of you might realize, the number of nosocomial infection by enterococcus,
especially enterococcus faecalis for the last two decades was rising. In America 2006-
2007, hidron reported that E. Faecalis was the 2nd most common cause of catheter
assosiated urinary tract infection or i called it CAUTI. This can be caused by
excessived antibiotics and a biofilm. In japan 2005, all of 352 E. Faecalis isolates from
UTI has produced biofilm. Clearly, this indicates biofilm has an important role of
CAUTI.
There are several methods to detect biofilm, for examples are tissue culture plate or
TCP and congo red agar or CRA. For now, TCP was used as a gold standard in some
research. For CRA, it is a phenotypic method, that using visual analysis to read the
results. There are still controversials about what method is most efficient for
detecting enterococcal biofilms. So in our research we wants to know, does CRA can
be used as a method to detect biofilm production of enterococcus faecalis.
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Before we discuss the methods, i want to inform you how E. Faecalis form a biofilm.
First step, the planktonic cells will reversibly and irreversibly attached to a surface.
Then, it will make a monolayer structure and will keep growing and produce
extracelullar matrix contain extracelullar polymeric substances (EPS), polisaccharide,
protein, DNA and RNA. After that, biofilm cells form a 3 dimension structure. And if
its fully mature, detachment may occur and the planktonic cells may re attached to
another surface.
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For detection the biofilm, we used TCP as a gold standard. The results were read by
ELISA plate reader in optical density or OD in 595nm, and use ibrisimovic 2017
formula as reference for the interpretation of the results. And second, we used CRA
as a phenotypic method and use niveditha 2012 as reference, interpretation of the
results were red colony as a non biofilm, and black colony as a biofilm producer. As
you can see here, there are the procedures of two methods.

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In our observasion, the result of CRA is 9 isolates were positive for biofilm producer,
and 4 were non-biofilm. For TCP, 8 isolates (61,4%) were positive for biofilm
producer and categorized as weak, and moderate. None of them are strong biofilm
producer in TCP.
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From this table, we can reccomend that CRA can be used as a screening method to
detect biofilm. Because in this table, show us the value of sensitivity and specificity
from CRA compared to TCP as gold standard are 75% and 40%. Our observasion has
similar results to Rajkumar that shows CRA does have a higher sensitivity than TCP.
However, CRA does have a lack because its inability to determine the degree of E.
Faecalis to produce biofilm. Next slide (7)
From left picture, this was the result of our CRA, as you can see, A B C colonies are in
red colour indicates non-biofilm producer and D E F are in black colour indicates
biofilm producer. To determine the biofilm-forming isolates, we had difficulty
because subjective color reading.
The tables on the right shows us CRA doesnt have a problem to detect moderate
biofilm producer. But in weak section, CRA shows less result of positive biofilm
producers resulting a decrease in sensitivity. This happened too in non-biofilm
producer, CRA shows less results in non-biofilm producer, resulting a decrease in
specificity.
Last slide
The results of our observasion, show 61,4% E. Faecalis isolated from urine chateter
form biofilm with TCP method as gold standard. But TCP require more skills and time.
For CRA, it is a fast, cheap, and easy to use. The difficulty of subjective reading of the
results is a lack of CRA and have consequences to a less specificity result. From
diagnostic test, the value of sensitivity and specificity are 75% and 40%, it means CRA
can be used as a screening test method to detect biofilm production in E. Faecalis.