Association of virulence genes with biofilm formation in clinical Enterococcus faecalis isolates: a systematic review and meta-analysis.
Abdulhamit Çalı, Safiye Göçer
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and random-effects meta-analysis assessed associations between virulence gene carriage and microplate-measured biofilm formation in human clinical Enterococcus faecalis isolates. It included 26 studies and 1848 isolates. For strong versus non-strong biofilm formation, esp carriage was associated with higher odds (OR 2.34, 95% CI 1.32-4.13). Associations varied by gene and biofilm phenotype; esp was the most consistent finding in sensitivity analyses, but its presence alone was insufficient to predict biofilm phenotype.
Key findings
- For strong versus non-strong biofilm formation, esp was associated with higher odds (OR 2.34, 95% CI 1.32-4.13).
- For any biofilm versus none, significant associations were reported for asa1 (OR 2.55, 95% CI 1.39-4.67), esp (OR 2.71, 95% CI 1.82-4.04), agg (OR 1.87, 95% CI 1.25-2.78), and cylA (OR 2.17, 95% CI 1.20-3.91).
- Strong biofilm formation was also associated with efaA (OR 26.28, 95% CI 1.12-614.84) and sprE (OR 3.06, 95% CI 1.18-7.92); estimates were based on few studies and were imprecise.
- Sensitivity analyses found esp to be the most consistent association, while heterogeneity remained for strong biofilm formation.
Why it matters
The findings indicate that virulence gene carriage and biofilm phenotype are related in gene-specific and phenotype-dependent ways. This helps frame biofilm assessment as more complex than screening for a single gene: even the most consistent association, esp, does not by itself predict whether an isolate will form biofilm. The results also highlight uncertainty around some gene-specific estimates.
What to keep in mind
The efaA and sprE estimates were based on few studies and were imprecise; heterogeneity remained for strong biofilm formation.