Alzahrani Othman M, Uddin Fakhur, Mahmoud Samy F, Alswat Amal S, Sohail Muhammad, Youssef Mona
Department of Biology, College of Science, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
Medical Technologist, Department of Microbiology, Basic Medical Sciences Institute (BMSI), JPMC, Karachi 75510, Pakistan.
Life (Basel). 2022 Dec 16;12(12):2125. doi: 10.3390/life12122125.
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.
糖尿病是一种主要的非传染性疾病，也是复发性感染的一个危险因素。当前研究旨在调查糖尿病患者中肠杆菌科耐碳青霉烯类尿路病原体的患病率及抗生素敏感性。2018年1月至2018年12月期间，从诊断实验室收集了910株细菌分离株的数据。使用包括菌落特征、生化试验和API（20E）在内的传统方法对细菌分离株进行鉴定。利用临床和实验室标准协会（CLSI）推荐的方法测定超广谱β-内酰胺酶（ESBL）、金属β-内酰胺酶（MBL）和肺炎克雷伯菌碳青霉烯酶（KPC）的抗菌敏感性及表型特征。通过手工聚合酶链反应（PCR）和Check-MDR CT103XL基因芯片对表型阳性分离株进一步分析其耐药编码基因。按照CLSI指南检测对黏菌素和头孢地尔的敏感性。数据显示，大多数患者患有2型糖尿病，病程超过一年且血糖水平未得到控制。大肠埃希菌和肺炎克雷伯菌是最常见的病原体，其次是阴沟肠杆菌和奇异变形杆菌。超过50%的分离株对22种抗生素耐药，对四环素、氨苄西林和头孢唑林的耐药率最高（>80%）。尿路病原体对包括阿米卡星、磷霉素和呋喃妥因在内的非β-内酰胺类抗生素耐药性较低。在表型检测中，发现495株（54.3%）分离株为ESBL产生菌，而ESBL-TEM和-PER是最常见的ESBL类型。对碳青霉烯类的耐药率略低于ESBL产生菌（250株；27.5%），但在大肠埃希菌分离株中更为常见。MBL产生是耐碳青霉烯类分离株的一个常见特征（71.2%）；基因特征分析也证实了这一趋势。分离株对新药头孢地尔和依拉环素敏感，耐药率为7%-28%，但奇异变形杆菌对依拉环素的耐药率为100%。本研究得出结论，从糖尿病患者分离出的尿路病原体中，几种类型的ESBL和碳青霉烯酶很常见，需要重新审视抗生素管理计划，尤其是为了治愈糖尿病患者的尿路感染。
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