# Characterization of the Phenotypic and Genotypic Antibiotic Resistance Markers in Escherichia coli (E. coli) Associated With Diabetes and Nondiabetic Patients

## TL;DR

This study compares antibiotic resistance in E. coli from diabetic and non-diabetic patients, finding higher resistance rates in diabetics but no significant difference in resistance profiles.

## Contribution

The study identifies the most common ESBL genotype (blaCTX-M) in E. coli isolates from diabetic and non-diabetic patients.

## Key findings

- E. coli was the most prevalent uropathogen in both diabetic and non-diabetic patients.
- blaCTX-M was the most common ESBL gene detected in E. coli isolates.
- High resistance was observed for ampicillin, cefuroxime, ciprofloxacin, and trimethoprim.

## Abstract

Introduction: Individuals with diabetes are more susceptible to urinary tract infections (UTIs) than those without the disease. This study aimed to determine the phenotypic and genotypic antibiotic resistance profiles of Escherichia coli in diabetic and nondiabetic patients.

Methodology: A total of 374 clean-catch midstream urine specimens were screened for uropathogens, and antibiogram analysis was done on E. coli isolates by the Kirby–Bauer disc diffusion method, followed by phenotypic confirmation of extended spectrum beta-lactamase (ESBL) production. In addition, polymerase chain reaction (PCR) assays were carried out to determine ESBL genotypes.

Result: Overall, we observed UTIs prevalence of 19.8% and 10.7% in diabetic and nondiabetic patients. Females exhibited higher UTI prevalence than males in both groups ([71.8% and 28.2%] vs. [85% and 15%]) (p < 0.0001). Among women with and without diabetes, the age groups of 55–64 and 25–34 years showed the highest prevalence of UTIs (25.6% vs. 40%). The most prevalent uropathogen was E. coli (62.2% vs. 75%); multidrug-resistant (MDR) E. coli was (61% vs. 33.3%) and ESBL–E. coli was (34.8% and 20%) in diabetic and nondiabetic patients, respectively. The most common ESBL-mediated gene was blaCTX-M (64.3%) with multiple ESBL genes in some E. coli isolates. High-level resistance was observed for ampicillin (91.2%), cefuroxime (96.7%), ciprofloxacin (44.9%), and trimethoprim (59.4%), and low-level resistance was observed for gentamicin (18.7%), ceftriaxone (20.9%), and nitrofurantoin (19.8%). There was no significant difference between antibiotic resistance in diabetic and nondiabetic patients (p > 0.05).

Conclusion: We observed blaCTX-M as the most common ESBL genotype, in combination with other ESBL genes present in some E. coli isolates. Nitrofurantoin and ceftriaxone antibiotics were efficacious. Appropriate prescription of antibiotic therapy, and the prevention of transmission of resistant genes in the context of public health can be facilitated by routine monitoring of the resistance profiles and ESBL markers in patients with and without diabetes.