Molecular Epidemiology of ESBL-Producing Uropathogenic Escherichia Coli and its Association with Biofilm Formation among Women with UTIs in Irbid, Jordan

This cross-sectional study investigated the molecular epidemiology and biofilm-forming capacity of ESBL-producing Escherichia coli among women (18–50 years) diagnosed with UTIs in Najaf, Iraq. Out of the total 300 urine samples, 183 (61.0%) yielded E. coli, with 77 isolates (42.1%) phenotypically confirmed as ESBL producers. All the 70 available ESBL+ isolates underwent molecular and biofilm analysis; seven isolates were excluded due to low viability or failure to recover after cryopreservation. The PCR revealed blaCTX-M in 90% (63/70) of isolates, solely (58.6%) or combined with blaOXA (31.4%). The biofilm formation was assessed through the microtiter plate method. A significant majority (68.6%, 48/70) of ESBL+ isolates formed moderate-to-strong biofilms, compared to only 31.2% of non-ESBL isolates (p < 0.01, Chi-square). Notably, among ESBL+ isolates, strong biofilm formation was significantly more prevalent in married women (37.8%, 14/37) as compared to unmarried women (18.2%, 6/33) after adjusting for age and prior antibiotic use (adjusted OR = 3.12; 95% CI: 1.02– 9.56; p = 0.046). The near-equal distribution of ESBL+ infections between married (53%) and unmarried (47%) women indicated a broad community circulation beyond traditional risk factors. The dominant blaCTX-M prevalence aligned with regional patterns, which emphasized a unified resistance landscape. Based on the high resistance and biofilm prevalence, empirical utilization of nitrofurantoin is strongly recommended. This study highlighted the dual threat of genetic resistance and biofilm-mediated persistence, advocating for integrated molecular and virulence diagnostics in routine gynecological care to guide targeted therapy and infection control strategies in Jordan and similar settings.