Occurrence of CTX-M and qnrA Genes Among ESBL-Producing Pseudomonas aeruginosa Isolated from Patients with Diabetic Foot Ulcers Attending ATBUTH Bauchi
DOI:
https://doi.org/10.54987/jobimb.v12i2.1068Keywords:
Diabetes foot ulcer, Pseudomonas aeruginosa, ESBL, Antimicrobial resistance, Molecular analysisAbstract
Diabetic foot ulcers (DFUs) pose a significant global health challenge due to its association with high morbidity and mortality rates. These chronic lesions, prevalent among individuals with diabetes mellitus (DM), result from a complex interplay of factors including peripheral neuropathy, peripheral artery disease, trauma, and impaired wound healing. Pseudomonas aeruginosa, a notorious pathogen linked to DFU infections, exhibits inherent resistance mechanisms and biofilm formation capabilities, complicating treatment strategies. This study aimed to assess the occurrence of CTX-M and qnrA genes among ESBL-producing P. aeruginosa isolates from DFUs patients at Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) in Bauchi, Nigeria. From 150 collected samples, P. aeruginosa was the most frequently isolated organism (37 isolates). Antimicrobial susceptibility testing revealed significant resistance to cephalosporins and fluoroquinolones, with 46.7% of isolates exhibiting ESBL production. Molecular analysis identified the presence of CTX-M genes in three ESBL-producing isolates while qnrA genes were not detected, the absence of qnrA suggests a lack of plasmid-mediated quinolone resistance in the isolates. Clinically, this finding could imply that quinolone-based treatment may still effective against infection. These findings underscore the urgent need for antimicrobial stewardship and tailored treatment strategies to address multidrug-resistant P. aeruginosa infections in DFU patients, emphasizing the importance of molecular surveillance to inform targeted interventions and improve patient outcomes.
References
Rubio JA, Jiménez S, Lázaro-Martínez JL. Mortality in patients with diabetic foot ulcers: causes, risk factors, and their association with evolution and severity of ulcer. J Clin Med. 2020;9(9):3009.
Costa D, Ielapi N, Caprino F, Giannotta N, Sisinni A, Abramo A, et al. Social aspects of diabetic foot: a scoping review. Soc Sci. 2022;11(4):149.
Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49(2):106-16.
Aldana PC, Cartron AM, Khachemoune A. Reappraising diabetic foot ulcers: a focus on mechanisms of ulceration and clinical evaluation. Int J Low Extrem Wounds. 2022;21(3):294-302.
Mairghani M. Diabetic foot ulcers (DFU) in Bahrain: an epidemiological profile of the prevalence, clinical care, economic cost and impact on quality of life. [PhD Thesis]. Royal Coll Surg Ireland; 2022 [cited 2024 Mar 17]. Available from: https://repository.rcsi.com/articles/thesis/Diabetic_Foot_Ulcers_DFU_in_Bahrain_An_Epidemiological_Profile_of_the_Prevalence_Clinical_Care_Economic_Cost_and_Impact_on_Quality_of_Life_/20509446
Ousey K, Chadwick P, Jawie? A, Tariq G, Nair HKR, Lázaro-Martínez JL, et al. Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives. J Wound Care. 2018;27(Suppl 5):S1-52.
Raja JM, Maturana MA, Kayali S, Khouzam A, Efeovbokhan N. Diabetic foot ulcer: a comprehensive review of pathophysiology and management modalities. World J Clin Cases. 2023;11(8):1684.
Malallah HA, Al-Mashhady FR, AL-Kefaei GHN. Detection and study of blaIMP and blaOXA genes in Pseudomonas aeruginosa isolates from diabetic foot ulcers in diabetic patients. Med Sci J Adv Res. 2024;4(4):287-93.
Nikoloudi M, Eleftheriadou I, Tentolouris A, Kosta OA, Tentolouris N. Diabetic foot infections: update on management. Curr Infect Dis Rep. 2018;20(1):1-11.
Glen KA, Lamont IL. ?-lactam resistance in Pseudomonas aeruginosa: current status, future prospects. Pathogens. 2021;10(12):1638.
Nasir A, Iqbal MN, Hassan G, Abbas MA, Jawad H, Raheem A, et al. Frequency of most prevalent bacteria in wounds of diabetic foot ulcers and their antimicrobial susceptibility to different antibiotics. Pak J Med Health Sci. 2021;15:2223-5.
Albadri ATJ, Raheema RH, Melek HK. Characterization and molecular study to detect multidrug resistance bacteria isolated from patients with diabetic foot ulcers in Wasit province. Minist High Educ [Internet]. 2021 [cited 2024 Mar 17]. Available from: https://www.researchgate.net/profile/Rana-Raheema/publication/354494181_Characterization_and_Molecular_study_to_detect_Multidrug_Resistance_Bacteria_Isolated_from_Patients_with_Diabetic_Foot_Ulcers_in_Wasit_Province/links/613adb2cd1bbee063c5e1e65/Characterization-and-Molecular-study-to-detect-Multidrug-Resistance-Bacteria-Isolated-from-Patients-with-Diabetic-Foot-Ulcers-in-Wasit-Province.pdf
Xiong Y, Zhang C, Gao W, Ma Y, Zhang Q, Han Y, et al. Genetic diversity and co-prevalence of ESBLs and PMQR genes among plasmid-mediated AmpC ?-lactamase-producing Klebsiella pneumoniae isolates causing urinary tract infection. J Antibiot (Tokyo). 2021;74(6):397-406.
Ali SA, Hassan RM, Khairat SM, Salama AM. Plasmid-mediated quinolone resistance genes qnrA, qnrB, qnrC, qnrD, qnrS and aac(6')-Ib in Pseudomonas aeruginosa and Acinetobacter baumannii. Microbiol Res J Int. 2018;1-12.
Shahi SK, Kumar A. Isolation and genetic analysis of multidrug-resistant bacteria from diabetic foot ulcers. Front Microbiol. 2016;6:1-12.
Higgins O, Chueiri A, O'Connor L, Lahiff S, Burke L, Morris D, et al. Portable differential detection of CTX-M ESBL gene variants, blaCTX-M-1 and blaCTX-M-15, from Escherichia coli isolates and animal fecal samples using loop-primer endonuclease cleavage loop-mediated isothermal amplification. Microbiol Spectr. 2023;11(1):e03316-22.
Doma AO, Popescu R, Mitule?u M, Muntean D, Dégi J, Boldea MV, et al. Comparative evaluation of qnrA, qnrB, and qnrS genes in Enterobacteriaceae ciprofloxacin-resistant cases, in swine units and a hospital from Western Romania. Antibiotics. 2020;9(10):698.
Okafor JU, Nwodo UU. Antibiogram profile and detection of resistance genes in Pseudomonas aeruginosa recovered from hospital wastewater effluent. Antibiotics. 2023;12(10):1517.
Guo LL, Li LM, Li Y, Duan XX, Liu YJ, Gao R. Characterization of antimicrobial resistance and virulence genes of Pseudomonas aeruginosa isolated from mink in China, 2011-2020. Microb Pathog. 2022;162:105323.
Tanko N, Bolaji RO, Olayinka AT, Olayinka BO. A systematic review on the prevalence of extended-spectrum beta-lactamase-producing Gram-negative bacteria in Nigeria. J Glob Antimicrob Resist. 2020;22:488-96.
Olowo-Okere A, Ibrahim YKE, Olayinka BO. Molecular characterisation of extended-spectrum ?-lactamase-producing Gram-negative bacterial isolates from surgical wounds of patients at a hospital in North Central Nigeria. J Glob Antimicrob Resist. 2018;14:85-9.
Anjum H, Arefin MS, Jahan N, Oishee MJ, Nahar S, Islam S, et al. Roles of intrinsic and acquired resistance determinants in multidrug-resistant clinical Pseudomonas aeruginosa in Bangladesh. Bangladesh J Med Sci. 2023;22(3):489-507.
Gondal AJ, Choudhry N, Bukhari H, Rizvi Z, Jahan S, Yasmin N. Estimation, evaluation and characterization of carbapenem resistance burden from a tertiary care hospital, Pakistan. Antibiotics. 2023;12(3):525.
Mustafai MM, Hafeez M, Munawar S, Basha S, Rabaan AA, Halwani MA, et al. Prevalence of carbapenemase and extended-spectrum ?-lactamase producing Enterobacteriaceae: a cross-sectional study. Antibiotics. 2023;12(1):148.
Qudus MS, Sehgal SA, Ahmed J, Khan M, Mumtaz S, Arshad M, et al. Prevalence of extended-spectrum ?-lactamases in multi-drug-resistant Pseudomonas aeruginosa from diabetic foot patients. Endocr Metab Immune Disord Drug Targets. 2019;19(4):443-8.
Rahamathullah N, Ragupathi P, Khamisani V, Sadiq AF, Mobiddo MA, Bagchi S, et al. Prevalence of class A ESBL, class B and D carbapenemase encoding genes (CTX-M, TEM, SHV, NDM, IMP, OXA-48) in gram-negative bacterial pathogens isolated from various clinical samples collected from northern region of United Arab Emirates. medRxiv. 2024;2024-01.
Salem M, Younis G, Sadat A, Nouh NAT, Binjawhar DN, Abdel-Daim MM, et al. Dissemination of mcr-1 and ?-lactamase genes among Pseudomonas aeruginosa: molecular characterization of MDR strains in broiler chicks and dead-in-shell chicks infections. Ann Clin Microbiol Antimicrob. 2024;23(1):9.
Saki M, Farajzadeh Sheikh A, Seyed-Mohammadi S, Asareh Zadegan Dezfuli A, Shahin M, Tabasi M, et al. Occurrence of plasmid-mediated quinolone resistance genes in Pseudomonas aeruginosa strains isolated from clinical specimens in southwest Iran: a multicenter study. Sci Rep. 2022;12(1):2296.
Wong A, Kassen R. Parallel evolution and local differentiation in quinolone resistance in Pseudomonas aeruginosa. Microbiology (Reading). 2011;157(4):937-44.
Glen KA, Lamont IL. ?-lactam resistance in Pseudomonas aeruginosa: current status, future prospects. Pathogens. 2021;10(12):1638.
Raja JM, Maturana MA, Kayali S, Khouzam A, Efeovbokhan N. Diabetic foot ulcer: a comprehensive review of pathophysiology and management modalities. World J Clin Cases. 2023;11(8):1684.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Abdullahi Aliyu Jibo, Usman Aliyu Dutsinma, Mahmud Yerima Iliyasu, Abubakar Musa
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
