Detection of Multidrug Resistant Bacterial Infections Isolated from Patients with Diabetics Foot Ulcers in Iraq

Thamer Akram  Matar; Nadia Ibrahim  Saleh

Thamer Akram Matar Tikrit University College of Medicine, Iraq
Nadia Ibrahim Saleh Tikrit University College of Medicine, Iraq

Keywords: Diabetes, multidrug resistant, foot ulcer, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumonia, Staphylococcus aureus, Streptococcus pyogenes

Abstract

Diabetes represent a chronic disorder that involve the decline in the levels of insulin produced by the pancreas due to many genetic and environmental factors. The disease involves the elevation of blood sugar in the circulation which may lead to vascular, neurological, ocular and renal complications. In addition, diabetic patients tend to develop ulceration due to wound infection swiftly in the lower limbs due to the reduce in the neurological sensation as well as to elevated sugar circulation which may greatly provoke wound infection and diabetic foot ulcerations. The current study aimed at isolation of the common causes of bacterial infection associated with diabetic foot ulcer, The present study was conducted in Salah Aldeen province during the period from 1^st of November 2023 to 15^th of May 2024 and included 150 patients with diabetic foot infection who attended Salah-Alden Hospitals: (Tikrit Teaching Hospital, Balad General Hospital and private surgery clinics). Swabs and whole blood from patients with diabetic foot ulcer were taken and submitted to routine culture and identification of the causative bacterial infection followed by biochemical identification and antibiotics susceptibility test for the isolated microbe. The current data revealed that most of the patients with diabetic foot ulcer were males 59.33% while females represented 40.67% with mean age 48 years for males and 53 years for females. Most of the patients with diabetic foot ulcer were residing urban areas 80.67% while the remaining 19.33% were living in rural areas. On the other hand, 18% of diabetic patients with foot ulceration were complaining of hypertension with majority having no other associated diseases 67.33%. Regarding bacterial isolates from diabetic foot ulceration, out of 150 clinical swabs only 47.33% were positive for bacterial isolates with predominant bacterial species species being Pseudomonas aeruginosa 38.03% followed by Escherichia coli 22.53%, Klebsiella pneumonia 19.71%, Staphylococcus aureus 11.26% and Streptococcus pyogenes 8.45%. Antibiotics susceptibility test depicted that all isolates of P. aeruginosa 100% were resistant amoxicillin, ciprofloxacin and levofloxacin, while most of them were susceptible to imipenem 91%. whereas the vast isolates were resistant to amoxicillin group. Similarly, E. coli showed 93.7% resistance to amoxicillin group while 100% sensitivity to ciprofloxacin and levofloxacin antibiotics. Whereas, 92.9% of K. pneumonia isolates were resistant to amoxicillin and azithromycin and 100% sensitive to imipenem. In the same way, 50% of S. aureus isolates were resistant to ceftazidime and 100% susceptible to imipenem. As for S. pyogenes 100% of the isolates were resistant to amoxicillin while 100% sensitive to cefixime, cefotaxime, amikacin, gentamycin and imipenem.

References

R. Hammad et al., "T-Natural Killers and Interferon Gamma/Interleukin 4 in Augmentation of Infection in Foot Ulcer in Type 2 Diabetes," Diabetes, Metab. Syndr. Obes., pp. 1897–1908, 2021.

C. Morgovan et al., "An Exploratory Research of 18 Years on the Economic Burden of Diabetes for the Romanian National Health Insurance System," Int. J. Environ. Res. Public Health, vol. 17, p. 4456, 2020.

B. Uivaraseanu et al., "Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome," Medicina (B. Aires), vol. 56, p. 380, 2020.

X. Yan, J. Song, L. Zhang, and X. Li, "Analysis of Risk Factors for Multidrug-Resistant Organisms in Diabetic Foot Infection," BMC Endocr. Disord., vol. 22, p. 46, 2022.

T. M. Walker et al., "Whole-Genome Sequencing for Prediction of Mycobacterium Tuberculosis Drug Susceptibility and Resistance: A Retrospective Cohort Study," Lancet Infect. Dis., vol. 15, pp. 1193–1202, 2015.

E. Goldman and L. H. Green, Practical Handbook of Microbiology, CRC Press, 2015.

M. H. Al-Allak, N. S. K. Al-Khafaji, and H. O. M. Al-Dahmoshi, "Microbial and Resistance Profile Among Diabetic Foot-Infections," EurAsian J. Biosci., vol. 13, 2019.

M. R. ALmuhana and M. H. Al-Ammar, "Phenotypic and Genotypic Detection of Multidrug Resistance of Pseudomonas Aeruginosa and Burkholderia Cepacia Isolated From Patients With Diabetes Foot Ulcer in Al Najaf Province," 2020.

S. M. Sekhar, N. Vyas, M. K. Unnikrishnan, G. S. Rodrigues, and C. Mukhopadhyay, "Antimicrobial Susceptibility Pattern in Diabetic Foot Ulcer: A Pilot Study," Ann. Med. Health Sci. Res., vol. 4, pp. 742–745, 2014.

A. J. Abdul-Razzak and Z. A. Al-Faddagh, "Reduction of Postoperative Wound Infection After Appendectomy by Peritoneal Closure and Wound Irrigation With Normal Saline," Basrah J. Surg., vol. 18, 2012.

N. Salh and S. Turki, "Assessment of Causes of Wounds Infection (WI) After Caesarean Section at Al-Batol Teaching Hospital in Iraq," Kufa J. Nurs. Sci., vol. 12, 2022.

O. K. Abdulhameed, "Infections Complicating Cesarean Section Wound: Prevalence and Associated Risk Factors in Iraq," Ann. Trop. Public Health, vol. 24, pp. 131–137, 2021.

H. M. Abdulghani et al., "Prevalence of Diabetic Comorbidities and Knowledge and Practices of Foot Care Among Diabetic Patients: A Cross-Sectional Study," Diabetes, Metab. Syndr. Obes. Targets Ther., pp. 417–425, 2018.

M. A. Gershater and J. Apelqvist, "Elderly Individuals With Diabetes and Foot Ulcer Have a Probability for Healing Despite Extensive Comorbidity and Dependency," Expert Rev. Pharmacoecon. Outcomes Res., vol. 21, pp. 277–284, 2021.

H. Mahmoudi, "Bacterial Co-Infections and Antibiotic Resistance in Patients With COVID-19," GMS Hyg. Infect. Control, vol. 15, 2020.

J. Yayan, B. Ghebremedhin, and K. Rasche, "No Development of Imipenem Resistance in Pneumonia Caused by Escherichia Coli," Medicine (Baltimore), vol. 94, 2015.

Z. Breijyeh, B. Jubeh, and R. Karaman, "Resistance of Gram-Negative Bacteria to Current Antibacterial Agents and Approaches to Resolve It," Molecules, vol. 25, p. 1340, 2020.

A. T. J. Albadri, R. H. Raheema, and H. K. Melek, "Characterization and Molecular Study to Detect Multidrug Resistance Bacteria Isolated From Patients With Diabetic Foot Ulcers in Wasit Province," Minist. High. Educ., 2021.

M. F. Alghoribi et al., "Antibiotic-Resistant ST38, ST131 and ST405 Strains Are the Leading Uropathogenic Escherichia Coli Clones in Riyadh, Saudi Arabia," J. Antimicrob. Chemother., vol. 70, pp. 2757–2762, 2015.

Y.-M. Zhong, W.-E. Liu, Q. Meng, and Y. Li, "Escherichia Coli O25b-ST131 and O16-ST131 Causing Urinary Tract Infection in Women in Changsha, China: Molecular Epidemiology and Clinical Characteristics," Infect. Drug Resist., pp. 2693–2702, 2019.

T. Kudinha et al., "Escherichia Coli Sequence Type 131 as a Prominent Cause of Antibiotic Resistance Among Urinary Escherichia Coli Isolates From Reproductive-Age Women," J. Clin. Microbiol., vol. 51, pp. 3270–3276, 2013.

P. N. A. Harris et al., "Dominance of ST131 Escherichia Coli Carrying bla CTX-M in Patients With Bloodstream Infections Caused by Cephalosporin-Resistant Strains in Australia, New Zealand and Singapore: Whole Genome Analysis of Isolates From a Randomised Trial," bioRxiv, p. 181768, 2017.

Z. Hojabri, N. Darabi, M. Arab, F. Saffari, and O. Pajand, "Clonal Diversity, Virulence Genes Content and Subclone Status of Escherichia Coli Sequence Type 131: Comparative Analysis of E. Coli ST131 and Non-ST131 Isolates From Iran," BMC Microbiol., vol. 19, pp. 1–10, 2019.

I. Ali et al., "Phylogeny, Sequence-Typing and Virulence Profile of Uropathogenic Escherichia Coli (UPEC) Strains From Pakistan," BMC Infect. Dis., vol. 19, pp. 1–9, 2019.

B. Li et al., "Prevalence and Characteristics of ST131 Clone Among Unselected Clinical Escherichia Coli in a Chinese University Hospital," Antimicrob. Resist. Infect. Control, vol. 6, pp. 1–9, 2017.

M. H. Namaei et al., "First Report of Prevalence of CTX-M-15-Producing Escherichia Coli O25b/ST131 From Iran," Microb. Drug Resist., vol. 23, pp. 879–884, 2017.

J. Huang, F. Lan, Y. Lu, and B. Li, "Characterization of Integrons and Antimicrobial Resistance in Escherichia Coli Sequence Type 131 Isolates," Can. J. Infect. Dis. Med. Microbiol., vol. 2020, p. 3826186, 2020.

C.-H. Lee et al., "Hypermucoviscosity Associated With Klebsiella Pneumoniae-Mediated Invasive Syndrome: A Prospective Cross-Sectional Study in Taiwan," Int. J. Infect. Dis., vol. 14, pp. e688–e692, 2010.

H. M. Ameen, N. B. Mahdi, and A. M. K. Eldin, "Investigation of Secondary Bacterial Lung Infections Associated With Corona Virus Covid-19, and the Extent of Their Resistance to Some Types of Antibiotics in the City of Kirkuk," NVEO-Natural Volatiles Essent. Oils J., pp. 9153–9161, 2021.

R. Ranjbar, H. Memariani, R. Sorouri, and M. Memariani, "Distribution of Virulence Genes and Genotyping of CTX-M-15-Producing Klebsiella Pneumoniae Isolated From Patients With Community-Acquired Urinary Tract Infection (CA-UTI)," Microb. Pathog., vol. 100, pp. 244–249, 2016.

H. K. Abdul-Mohsin and H. H. Al-Hasnawy, "Occurrence of erm and MSRA Genes in Inducible Clindamycin Resistance of Methicillin-Resistant Staphylococcus Aureus Isolated From Different Clinical Specimens in Al Hilla, Iraq," Biochem. Cell. Arch., vol. 20, 2020.

Y. Hao et al., "Molecular Characterization of Klebsiella Pneumoniae Isolated From Sputum in a Tertiary Hospital in Xinxiang, China," Infect. Drug Resist., vol. 15, pp. 3829–3839, 2022.