Resistance to Some New Drugs and Prevalence of ESBL- and MBL-Producing Enterobacteriaceae Uropathogens Isolated from Diabetic Patients

Abstract

Diabetes is a leading non-communicable disease and a risk factor for relapsing infections. The current study was aimed at investigating the prevalence and antibiotic susceptibility of carbapenem-resistant (CR) uropathogens of the family Enterobacteriaceae in diabetic patients. The data of 910 bacterial isolates was collected from diagnostic laboratories during January 2018 to December 2018. The bacterial isolates were identified using traditional methods including colonial characteristics, biochemical tests, and API (20E). Antimicrobial susceptibility and phenotypic characterization of ESBL, MBLs, and KPC was determined by utilizing CLSI recommended methods. The phenotypically positive isolates were further analyzed for resistance-encoding genes by manual PCR and Check-MDR CT103XL microarray. Susceptibility to colistin and cefiderocol was tested in accordance with CLSI guidelines. The data revealed that most of the patients were suffering from type 2 diabetes for a duration of more than a year and with uncontrolled blood sugar levels. Escherichia coli and Klebsiella pneumoniae were the most frequently encountered pathogens, followed by Enterobacter cloacae and Proteus mirabilis. More than 50% of the isolates showed resistance to 22 antibiotics, with the highest resistance (>80%) against tetracycline, ampicillin, and cefazolin. The uropathogens showed less resistance to non-β-lactam antibiotics, including amikacin, fosfomycin, and nitrofurantoin. In the phenotypic assays, 495 (54.3%) isolates were found to be ESBL producers, while ESBL-TEM and -PER were the most prevalent ESBL types. The resistance to carbapenems was slightly less (250; 27.5%) than ESBL producers, yet more common amongst E. coli isolates. MBL production was a common feature in carbapenem-resistant isolates (71.2%); genotypic characterization also validated this trend. The isolates were found to be sensitive against the new drugs, cefiderocol and eravacycline. with 7–28% resistance, except for P. mirabilis which had 100% resistance against eravacycline. This study concludes that a few types of ESBL and carbapenemases are common in the uropathogens isolated from the diabetic patients, and antibiotic stewardship programs need to be revisited, particularly to cure UTIs in diabetic patients.

In Vitro Activity of New β-Lactamase Inhibitor Combinations against blaNDM, blaKPC, and ESBL-Producing Enterobacteriales Uropathogens

“…The resistance patterns of both groups (ward and OPD) of the isolates showed higher resistance to penicillin, cephalosporins, and quinolones. This is consistent with the results of a previous study [25].…”

Prevalence of β-lactamase enzyme producing uropathogenic E.coli isolates amongst diabetic and non-diabetic patients

“…Carbapenemase are another important group of βlactamases, belonging to different ambler classes (A, B, D) can hydrolyze broad range of βlactams including penicillin, cephalosporin, aztreonam and carbapenem. The present findings were correlated with the previous study reports that 127/142 (89.4%) UPEC isolates were carbapenemase producers by phenotypic method [38] and the prevalence of 31.3% (36/115) UPEC were metallo β-Lactamase by Modified Hodge Test [39].…”

“…(TEM), Sulfhydryl Variable (SHV) and Cefotaximase (CTX-M). Prevalence of ESBL coding genes among diabetic isolates in the present investigation were higher than one of the similar study reports that 58.2% of phenotypically ESBL producers among these 26.6% harbor blaTEM and 12.5% harbor blaCTX-M among diabetic UPEC [38]. ESBL production in Type 2 diabetic UPEC (25.8%) were positively correlated with old age, urinary catheterization, discriminate use of antibiotics and acute kidney injury [24].…”

Resistance profile of urine isolate enterobacteral strains at Donka University teaching hospital in Conakry, Guinea

“…These species are considered the most commonly isolated around the world, both in community and hospital settings. Some studies conducted in Germany, Espana, Peruvia, Ethiopia, Tanzania, and Ghana highlighted the same constatation (Abubaker and Anwar, 2023;Alzahrani et al, 2022;Donkor et al, 2019;Moges et al, 2021;Rondon et al, 2023;Schmider et al, 2022;Stoltidis-Claus et al, 2023). However, this pattern may vary in certain areas, as seen in a study conducted in Sierra Leone, where samples from the community showed a predominance of Citrobacter freundii strains (Leski et al, 2016) and another study among elderly patients living in the community and in the nursing home showed that Proteus mirabilis was the second strains isolated after E. coli (Pulcini et al, 2019).…”