Extended spectrum β-lactamase genes in type II diabetic patients with asymptomatic bacteriuria in Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State

Abstract

Background: Antibiotic resistance has become one of the most important clinical challenges today, so also is diabetes mellitus. The immune and metabolic deficiency state in diabetic patients predisposes them to lots of nosocomial and community acquired infections which may remain asymptomatic and the causative organism may already possess antibiotic resistance genes at that level. Aim: Isolation and Identification of uropathogens from type II diabetes outpatients with significant asymptomatic bacteriuria, antibiotic sensitivity profiling of the uropathogens to cephalosporins, identification of extended spectrum beta lactamase producing uropathogens and genes conferring resistance. Methods: Isolates from samples with significant bacteriuria were identified and subjected to antibiotic susceptibility test by Kirby-Bauer disk diffusion method. Multidrug resistant isolates were screened for beta lactamase production by the starch iodometric method and double disk synergy test respectively followed by Multiplex PCR for genotyping for ESBL genes. Results: Out of the 200 patient screened for significant bacteriuria, 29 (14.5%) presented with significant bacteriuria, 2 were symptomatic while 27 were asymptomatic. Prevalent uropathogens isolated were Escherichia coli (44%), Proteus mirabilis (19%) and Klebsiella pneumoniae (15%). 100% resistance was recorded for cefepime and ceftazidime, 41% for ceftriaxone, 37% for cefuroxime and 4% for imipenem. Electrophoresis of PCR products confirmed that the uropathogens carried blaCTX and blaSHV genes. Conclusion: Cephalosporins being used as front line agents in treating urinary tract infections in type II diabetic patients are presently being rendered useless by antibiotic resistance genes. Continuous genetic study of antimicrobial resistance in pathogens is crucial for successful antimicrobial therapy.