Resistance to Some New Drugs and Prevalence of ESBL- and MBL-Producing Enterobacteriaceae Uropathogens Isolated from Diabetic Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Retrieval of Data, Bacterial Isolates, and Identification
2.2. Antimicrobial Susceptibility Testing
2.3. Phenotypic Characterization of ESBLs
2.4. Phenotypic Characterization of Carbapenemases
2.5. Genotypic Characterization of ESBLs and Carbapenemases
2.6. Statistical Analysis
3. Results
3.1. Clinical and Other Variables
3.2. Prevalence of Major Uropathogens and Antimicrobial Susceptibility Pattern
3.3. Resistance to Colistin
3.4. Phenotypic Resistance Categories
3.5. Phenotypic and Genotypic Characterization of Resistance Markers
3.6. Co-Existence of Resistance-Encoding Genes
3.7. Resistance to Cefiderocol and Eravacycline
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Primer | Sequence | Annealing Temperature °C | Product Size bp | Reference |
---|---|---|---|---|
TEM | F-ATGAGTATTCAACATTTCCG R-TTAATCAGTGAGGCACCTAT | 51 | 851 | Grimm et al., 2004 [24] |
SHV | F-GCAAAACGCCGGGTTATTC R-GGTTAGCGTTGCCAGTGCT | 57.4 | 940 | Gröbner at el., 2009 [25] |
PER | F-GCTCCGATAATGAAAGCGT R-TTCGGCTTGACTCGGCTGA | 53 | 520 | Uddin et al., 2022 [20] |
GES | F-GTT AGA CGG GCG TAC AAA GAT AAT R-TGT CCG TGC TCA GGA TGA GT | 55 | 903 | Ryoo et al., 2005 [26] |
CTX-M | F-CGCTTTGCGATGTGCAG R-ACCGCGATATCGTTGGT | 55.7 | 551 | Paterson et al., 2003 [27] |
NDM | F-CACCTCATGTTTGAATTCGCC R-CTCTGT CACATCGAAATCGC | 60 | 984 bp | Kaase et al., 2011 [28] |
KPC | F-CAGCTCATTCAAGGGCTTTC R-AGTCATTTGCCGTGCCATAC | 56 | 533 | Gröbner at el., 2009 [25] |
VIM | F-GGTGTTTGGTCGCATATCGC CCATTCAGCCAGATCGGCATC | 65 | 503 bp | Wolter et al., 2009 [29] |
IMP | F-GGAATAGAGTGGCTTAATTC R-CAACCAGTTTTG CCTTACC | 53 | 327 bp | Wolter et al., 2009 [29] |
Name of Variable | Occurrence |
---|---|
Type of DM | |
Type 1 | 264 (29.02%) |
Type 2 | 646 (70.98%) |
Gender | |
Male | 209 (22.96%) |
Age (years) | |
1–20 | 1 (0.47%) |
20–40 | 32 (15.31%) |
40–60 | 107 (51.19%) |
60–80 | 61 (29.18%) |
>80 | 8 (3.82%) |
Female | 701 (77.03%) |
Age (years) | |
1–20 | 3 (0.42%) |
20–40 | 49 (6.99%) |
40–60 | 237 (33.81%) |
60–80 | 355 (50.64%) |
>80 | 57 (8.13%) |
Blood glucose level | |
Fasting Blood Sugar * | |
≥120 | 115 (12.63%) |
<120 | 795 (87.36%) |
HbA1c | |
<6.5%) | 293 (32.2%) |
>6.5% | 617 (67.8%) |
Duration of DM | |
<1 year | 72 (7.91%) |
1–10 years | 420 (46.15%) |
>10 years | 418 (45.94%) |
Pathogen | Prevalence |
---|---|
Escherichia coli | 536 (58.90%) |
Klebsiella pneumoniae | 337 (37.03%) |
Enterobacter cloacae | 19 (2.08%) |
Proteus mirabilis | 18 (1.97%) |
Antibiotics | E. coli (n = 536) | K. pneumoniae (n = 337) | Enterobacter cloacae (n = 19) | P. mirabilis (n = 18) | Total (n = 910) |
---|---|---|---|---|---|
AMC | 458 (85.44%) | 208 (61.72%) | 18 (94.73%) | 16 (88.89%) | 700 (76.91%) |
ATM | 382 (71.26%) | 203 (60.23%) | 16 (84.21%) | 15 (83.33%) | 616 (67.69%) |
SXT | 324 (60.44%) | 241 (71.51%) | 11 (57.89%) | 12 (66.67%) | 588 (64.61%) |
FEP | 402 (75.00%) | 210 (62.31%) | 13 (68.82%) | 11 (61.11%) | 636 (69.89%) |
FOX | 301 (56.16%) | 177 (52.52%) | 19 (100%) | 10 (55.55%) | 507 (55.71%) |
CAZ | 404 (75.37%) | 209 (62.01%) | 13 (68.82%) | 12 (66.67%) | 638 (70.10%) |
TE | 415 (77.42%) | 283 (83.97%) | 16 (84.21%) | 18 (100%) | 732 (80.43%) |
LEV | 406 (75.74%) | 239 (70.91%) | 16 (84.21%) | 14 (77.78%) | 675 (74.17%) |
GN | 301 (56.16%) | 216 (64.09%) | 17 (89.47%) | 14 (77.78%) | 548 (60.21%) |
F | 321 (59.88%) | 183 (54.30%) | 15 (78.94%) | 18 (100%) | 537 (59.01%) |
TZP | 441 (82.27%) | 204 (60.53%) | 15 (78.94%) | 14 (77.78%) | 674 (74,06%) |
NOR | 410 (76.49%) | 255 (75.66%) | 14 (73.68%) | 11 (61.11%) | 690 (75.82%) |
CIP | 410 (76.49%) | 255 (75.66%) | 11 (57.89%) | 12 (66.67%) | 688 (75.60%) |
MER | 138 (25.74%) | 91 (27.01%) | 04 (21.05%) | 05 (27.78%) | 238 (26.15%) |
IMP | 142 (26.49%) | 88 (26.11%) | 06 (31.57%) | 05 (27.78%) | 241 (26.45%) |
AMP | 465 (86.75%) | 263 (78.04%) | 19 (100%) | 16 (88.89%) | 763 (83.84%) |
CFZ | 462 (86.19%) | 260 (77.15%) | 19 (100%) | 15 (83.33%) | 756 (83.07%) |
FOS | 181 (33.76%) | 111 (32.93%) | 05 (26.31%) | 06 (33.33%) | 303 (33.29%) |
AK | 176 (32.83%) | 177 (52.52%) | 13 (68.82%) | 10 (55.55%) | 376 (41.31) |
CRO | 406 (75.74%) | 230 (68.24%) | 19 (100%) | 15 (83.33%) | 670 (73.62%) |
ERT | 142 (26.49%) | 88 (26.11%) | 06 (31.57%) | 08 (44.44%) | 244 (26.81%) |
DOR | 142 (26.49%) | 88 (26.11%) | 07 (36.84%) | 10 (55.55%) | 247 (27.14%) |
Bacterial Isolate | Intermediate (≤2 µg/ mL) | Resistant (≥4 µg/mL) | Total n (%) |
---|---|---|---|
E. coli (n = 536) | 489 (91.24%) | 47 (8.76%) | 536(100) |
K. pneumoniae (n = 337) | 302 (89.62%) | 35 (10.38%) | 337(100) |
Enterobacter cloacae (n = 19) | 18 (94.74%) | 1 (5.26%) | 19(100) |
P. mirabilis (n = 18) | 00 | 18 (100%) | 18(100) |
Total (n = 910) | 809 (88.90%) | 101 (11.10%) | 910(100) |
Isolates | Phenotypic Detection | Manual PCR (n = 495) (%) | Microarray Assay (n = 495) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
TEM | PER | GES | CTX-M | Unrecognized | TEM | PER | GES | CTX-M | Unrecognized | ||
E. coli | 312 (58.2) | 83 (26.6) | 134 (42.9) | 34 (10.8) | 39 (12.5) | 22(7.0) | 85 (27.2) | 139 (44.5) | 36 (11.5) | 41 (13.14) | 11 (3.52) |
K. pneumoniae | 165 (48.9) | 55 (33.3) | 79 (47.8) | 5 (3.0) | 13 (7.8) | 13(7.8) | 59 (35.7) | 81 (49) | 6 (3.6) | 14 (8.48) | 05 (3.0) |
Enterobacter cloacae | 08 (42.1) | 02 (25) | 02 (25) | 00 | 3 (37.5) | 1 (12.5) | 02 (25) | 02 (25) | 0 | 04 (50) | Nil |
P. mirabilis | 10 (55.5) | 02 (20) | 02 (20) | 02 (20) | 02 (20) | Nil | 04 (40) | 02 (20) | 02 (20) | 02 (20) | Nil |
Total n (%) | 495 (54.3) | 134 (27) | 207 (41.8) | 36 (7.2) | 53 (10.7) | 36(7.2) | 150 (30.3) | 224 (45.2) | 44 (8.8) | 61 (12.32) | 16 (3.23) |
Isolates | Phenotypic Methods | Total (%) | Manual PCR | Microarray Assay | ||||
---|---|---|---|---|---|---|---|---|
blaNDM | blaKPC | Unrecognized | blaNDM | blaKPC | Unrecognized | |||
E. coli (n = 142) | MBL | 107 (75.35%) | 109 (76.7%) | 24 (16.90%) | 9 (6.33%) | 111 (78.16%) | 24 (16.90%) | 7 (4.92%) |
KPC | 21 (14.78%) | |||||||
Unrecognized | 14 (8.85%) | |||||||
K. pneumoniae (n = 91) | MBL | 61 (67.03%) | 64 (70.3%) | 27 (29.67%) | 00 | 64 (70.3%) | 27 (29.67%) | 0 |
KPC | 27 (29.67%) | |||||||
Unrecognized | 3 (3.29%) | |||||||
E. cloacae (n = 7) | MBL | 5 (71.42%) | 5 (71.42%) | 2 (28.58%) | 00 | 5 (71.42%) | 2 (28.58%) | 0 |
KPC | 2 (28.58%) | |||||||
Unrecognized | - | |||||||
P. mirabilis (n = 10) | MBL | 5 (50.0%) | 5 (50.0%) | 5 (50%) | 2 (20%) | 5 (50%) | 5 (50%) | 0 |
KPC | 3 (30.0%) | |||||||
Unrecognized | 2 (20%) | |||||||
Total (n = 250) | MBL | 178 (71.2%) | 183 (73.2%) | 55 (22%) | 11 (4.4%) | 188 (75.2%) | 55 (22%) | 7 (2.8%) |
KPC | 53 (21.2%) | |||||||
Unrecognized | 19 (7.6%) |
Isolate | Resistant to | |
---|---|---|
FDC | ERV | |
E. coli (n = 142) | 10 (7.04) | 19 (13.38) |
K. pneumoniae (n = 91) | 7 (7.69) | 9 (9.89) |
Enterobacter cloacae (n = 7) | 2 (28.57) | 1 (14.28) |
P. mirabilis (n = 10) | 1 (10.0) | 10 (100) |
Total (n = 250) | 20 (8.0) | 39 (15.6) |
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Alzahrani, O.M.; Uddin, F.; Mahmoud, S.F.; Alswat, A.S.; Sohail, M.; Youssef, M. Resistance to Some New Drugs and Prevalence of ESBL- and MBL-Producing Enterobacteriaceae Uropathogens Isolated from Diabetic Patients. Life 2022, 12, 2125. https://doi.org/10.3390/life12122125
Alzahrani OM, Uddin F, Mahmoud SF, Alswat AS, Sohail M, Youssef M. Resistance to Some New Drugs and Prevalence of ESBL- and MBL-Producing Enterobacteriaceae Uropathogens Isolated from Diabetic Patients. Life. 2022; 12(12):2125. https://doi.org/10.3390/life12122125
Chicago/Turabian StyleAlzahrani, Othman M., Fakhur Uddin, Samy F. Mahmoud, Amal S. Alswat, Muhammad Sohail, and Mona Youssef. 2022. "Resistance to Some New Drugs and Prevalence of ESBL- and MBL-Producing Enterobacteriaceae Uropathogens Isolated from Diabetic Patients" Life 12, no. 12: 2125. https://doi.org/10.3390/life12122125