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Title: Multi Drug Resistant Enterobacteriaceae: Diabetic Versus Non-Diabetic Infections.
Authors: Zainab Mohammed Dashti 
Supervisor: Dr. Leila Vali
Keywords: Diabetes Mellitus;MDR;Enterobacteriaceae in diabetic patients
Issue Date: 2016
Publisher:  Kuwait university - college of graduate studies
Abstract: It has been proven that diabetic patients are more prone to infections. This could place them at a higher risk of contracting multi drug resistant (MDR) bacteria, including members of the Enterobacteriaceae family, which are common causative agents in diabetic infections. Our main aim was to detect the prevalence of MDR Enterobacteriaceae in diabetic patients. Isolates from diabetic (n=65) and non-diabetic Patients (n=49) were collected, identified and screened for antibiotic resistance using Vitek 2 or MicroScan Walkway. Isolates of both groups were also compared by polymerase chain reaction (PCR) for extended spectrum beta lactamases (ESBLs) (blaCTX-M, blaSHV, blaTEM ), fluoroquinolone resistance genes (qnrA,B,S & aac(6’)-cr-Ib) and carbapenem resistant genes (blaIMP, blaGIM, blaVIM, blaKPC, blaOXA & blaNDM). Pulsed field gel electrophoresis (PFGE) was also used to compare E. coli and K. pneumoniae isolates of both groups. MDR was found to be significantly higher among the diabetic patients (78.5% vs 46.9%, P-value < 0.001). These isolates also showed a significantly higher resistance to ampicillin (P-value < 0.001), amoxicillin/clavulanic acid (P-value < 0.001), ceftazidime (P-value < 0.001), cefuroxime (P-value <0.001), cefotaxime ( P-value <0.014) sulfamethoxazole/trimethoprim (P-value < 0.029) and ciprofloxacin (P-value < 0.001). ESBL production was higher among the isolates causing infections in the diabetic group compared to the non-diabetic with PCR detection of blaTEM-1 (76% , vs 44%), blaCTX-M-15 (44%, vs 50%), blaSHV-2 (26%,vs 0%) & blaOXA-232 (6%,vs 0%). Regarding fluoroquinolone resistance PCR showed detection rates for aac(6’)-cr-Ib as follows (diabetic 18%, vs non-diabetic 13%), qnrA (0%, vs 0%), qnrB1 (7%, vs 0%) & qnrS1 (9%, vs 0%). We also detected for the first time in Kuwait the presence of blaOXA-232 in two K. pneumoniae isolates conferring resistance to imipenem and colistin. PFGE showed overall diversity for both E. coli and K .pneumoniae isolates. Our results, show high rates of MDR among Enterobacteriaceae isolated from the diabetic population of Kuwait, with the first reported emergence of blaOXA-232.
Appears in Programs:0712 Medical Laboratory Sciences

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