Social demographic factors, antimicrobial profiles and genotypic characterization of extended beta- lactamase producing uropathogens among adult diabetic patients 

• Author Details:   
• Ann Wanjiru Ngángá ^*
• Andrew Kimang'a Nyerere
• Edinah Kwamboka Song'oro
• Samson Nzou Muuo
• Robinson Mugasiali Irekwa

Introduction: Urinary tract infections among diabetic patients have been on the rise in Kenya and globally. They have been worsened by the rise of multi-drug-resistant strains against the commonly used Beta -lactam drugs. Relapse and re-infection have been observed among these patients.

Objectives: The study aims to investigate the antimicrobial resistance patterns, and socio-demographic factors associated with urinary tract infections (UTIs) among adult diabetic patients attending P.C.E.A Kikuyu and Lussiggetti Sub-County Hospitals in Kenya. Specifically, it seeks to determine how common UTIs are in the patient groups and to identify any socio-demographic characteristics that may influence their occurrence. The research will also focus on isolating and identifying the bacterial pathogens responsible for these infections and evaluating their antimicrobial susceptibility profiles. Additionally, the study will examine the presence of selected Extended Spectrum Beta-Lactamase (ESBL) resistance genes in the bacterial isolates, providing insight into the genetic mechanisms underlying antibiotic resistance in this population.

Materials and Methods: The study was carried out among diabetic patients attending Presbyterian Church of East Africa Kikuyu and Lussiggetti Sub- County hospitals in Kenya. A cross-sectional study where 95 diabetic patients were randomly selected. Data was collected in excel sheets and analyzed using SPSS.version 26: 2018.The Chi square was used to determine the relationship of UTI to several demographic factors with a P value of < 0.05 considered to be significant. Presence of UTI from the 95 samples was detected using dipstick analysis and urine culture on CLED agar. Isolate identification and Antimicrobial Susceptibility was done using the Minimum Inhibition Concentration technique on Vitek 2 compact machine. DNA extraction was done using QiaAmp kit and Multiplex PCR for the detection of ESBL genes from the ESBL producers identified using Double disk synergy testing.

Results: All the factors age, sex, weight, education, occupation, smoking none had significant relationship .10 /95 samples had a growth of 10^5CFU/ul with E. coli as the predominant, the rest were Enterococcus faecalis, Klebsciella pneumonia and Staphylococcus epidermidis. The organisms showed resistance to the Beta lactam drugs used, Multi drug resistance for the study was at 70%. E. coli susceptibility was found at 28.6% for Ampicillin, Ampicillin Sulbactam, Sulphamethazole. The drugs susceptible for the gram-negative organisms were Meropenem and Ciprofloxacin. The gram positive were resistant to Gentamicin, Sulphamethazole and clindamycin .8/10 samples were tested by molecular method and 5 were confirmed to harbor at least one ESBL gene. Bla TEM at 62.5% 5/8 followed by CTX-M at 25%, no SHV was isolated.

Conclusion: Multidrug resistance at 70% was observed thus still a burden among diabetic patients with UTI and intervention should be done to offer the right treatment. Studies on more genes of resistance that will aid on antimicrobial resistance reduction.