Prevalence of metallo-β-lactamase-producing isolated from diabetic foot infections in Iraq.

Metallo-β-lactamase (MBL)-producing is a major cause of nosocomial infections. However, there is little information in Iraq regarding its prevalence in patients with diabetic foot ulcer. Carbapenems are efficient antibiotics against extended-spectrum β-lactamase-producing . However, there are many potential health risks associated with carbapenem-resistant . We aimed to determine MBL-producing isolated from diabetic foot ulcer infections. A total of 97 isolates were isolated from pus and deep tissue swabs of 282 patients admitted to Al-Sader hospital, Najaf City, Iraq, with diabetic foot infections from October 2017 to January 2018. All isolates were tested by the Kirby-Bauer disc diffusion method for evaluating 13 antibiotics. Phenotypic carbapenem resistance was confirmed by the combined disc test, double-disc synergy test, modified Hodge test and CHROMagar KPC agar. All phenotypic MBL-producing isolates were screened for , , , and genes by multiplex PCR. Of the 97 isolates, combined disc test and modified Hodge test revealed 12 isolates (12.4%) to be MBL producers, and ten (10.3%) displayed MBL production as accessed by CHROMagar KPC agar test. Nine isolates (9.3%) were carbapenemase producers by the imipenem and ceftizoxime double-disc synergy test. Of 12 phenotypic MBL-producing , PCR amplification confirmed 4 (33.3%) and 3 (25%) isolates harbouring and gene respectively, but none carried the , or genes. The steady and rapid increase of MBL production is worrisome and needs to be controlled through extensive studies and more judicious selection of antibiotics, especially carbapenems.