title: Clinico-microbiological study and antibiotic resistance profile of mecA and ESBL gene prevalence in patients with diabetic foot infections.
abstract: Diabetic foot infections (DFIs) constitute a major complication of diabetes mellitus. DFIs contribute to the development of gangrene and non-traumatic lower extremity amputations with a lifetime risk of up to 25%. The aim of the present study was to identify the presence of neuropathy and determine the ulcer grade, microbial profile and phenotypic and genotypic prevalence of the methicillin-resistance gene mecA and extended spectrum β-lactamase (ESBL)-encoding genes in bacterial isolates of DFI in patients registered at the Pakistan Institute of Medical Sciences (Islamabad, Pakistan). The results indicated that 46/50 patients (92%), exhibited sensory neuropathy. The most common isolate wasStaphylococcus aureus(25%), followed byPseudomonas aeruginosa(P. aeruginosa; 18.18%),Escherichia coli(16.16%),Streptococcusspecies (spp.) (15.15%),Proteusspp. (15.15%),Enterococcusspp. (9%) andKlebsiella pneumoniae(K. pneumoniae; 3%). The prevalence of the mecA gene was found to be 88% phenotypically and 84% genotypically.K. pneumoniaewas shown to have the highest percentage of ESBL producers with a prevalence of 66.7% by double disk synergy test, and 100% by the cefotaxime + clavulanic acid/ceftazidime + clavulanic acid combination disk test.P. aeruginosaandK. pneumoniaehad the highest (100%) proportion of metallo β-lactamase producers as identified by the EDTA combination disk test. The overall prevalence of β-lactamase (bla)-CTX-M, bla-CTX-M-15, bla-TEM, bla-OXA and bla-SHV genes was found to be 76.9, 76.9, 75.0, 57.7 and 84.6%, respectively, in gram-negative DFI isolates. The prevalence of mecA and ESBL-related genes was found to be alarmingly high in DFIs, since these genes are a major cause of antibiotic treatment failure.
authors.affiliation: Department of Industrial Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad 44000, Pakistan.
authors.forename: Waqas Nasir
authors.initials: WN
authors.lastname: Chaudhry
authors.affiliation: Department of Industrial Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad 44000, Pakistan.
authors.forename: Rabia
authors.initials: R
authors.lastname: Badar
authors.affiliation: Department of Industrial Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad 44000, Pakistan.
authors.forename: Muhsin
authors.initials: M
authors.lastname: Jamal
authors.affiliation: Department of Industrial Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad 44000, Pakistan.
authors.forename: Jason
authors.initials: J
authors.lastname: Jeong
authors.affiliation: Department of Industrial Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad 44000, Pakistan.
authors.forename: Jamal
authors.initials: J
authors.lastname: Zafar
authors.affiliation: Department of Industrial Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad 44000, Pakistan.
authors.forename: Saadia
authors.initials: S
authors.lastname: Andleeb
keywords: antibiotic resistance; diabetic foot ulcer; extended spectrum β-lactamase; prevalence