Lineage-linked biofilm formation and widespread multidrug resistance among Indian Acinetobacter baumannii clinical isolates

Aims This study aimed to investigate the diversity and determinants of biofilm formation among clinical Acinetobacter baumannii Indian isolates and assess their relationship with antimicrobial resistance profiles, biofilm-associated genes, and genetic lineages revealed through whole-genome analysis. Methods and Results 230 A. baumannii clinical isolates across India (2015-2022) were tested for antibiotic susceptibility using the VITEK 2 system. Biofilm formation was quantified via the Tissue Culture Plate method. Whole genome sequencing (Illumina MiSeq) and bioinformatic analysis were performed to identify biofilm-associated genes, antimicrobial resistance genes and sequence types. Statistical associations were assessed using Kruskal-Wallis, Spearman's, and Fisher's tests. 85.22% of isolates were multidrug-resistant (MDR), and 100% exhibited biofilm formation, with 52.17% strong, 39.57% moderate, and 8.26% weak biofilm producers. Genes including ompA, bfmR, pgaA, pgaB, and pgaD were universally present. No significant association was observed between biofilm formation and antibiotic resistance (P = 0.55), specimen type (P = 0.54), or the presence of specific biofilm-related genes (P > 0.05). 21 sequence types (STs) were identified, with ST2 being the most prevalent (51.73%). Strong biofilm formation was more common in ST164, ST1, and ST575. Conclusions This study demonstrates a high prevalence of MDR and strong biofilm-forming A. baumannii isolates in India. Biofilm formation appeared independent of resistance or gene carriage but showed lineage-linked variation across sequence types.