Background:
Urinary tract Infection (UTI) is a significant health issue, ranked as the second most common infection, more prevalent in patients with diabetes mellitus (DM). UTI is often associated with severe complications, such as cystitis, pyelonephritis, and renal or perinephric abscesses, especially in patients with poor glycemic control.
Aim:
The aim of this study was to identify the potential virulence genes (cnf1 ,vanA ,efa ,AlgD, las-r,rhl-R mecA and pvl,) present in bacteria causing UTI thus contributing to the progression of infection among diabetic patients.
Methods:
1000 diabetic and non-diabetic urine samples were collected from various hospitals and diabetic centres across Bangalore city. Clean voided midstream urine samples were collected in sterile containers. Urine samples were processed in the lab following standard laboratory protocol.
Results:
Commonly recovered UTI isolates were E. coli, Enterococcus faecalis, Pseudomonas aeruginosa and Staphylococcus aureus. Antibiotic susceptibility was performed using the disc diffusion method (Kirby-Beur). Results of antibiotic sensitivity tests were recorded by measuring the Zone of inhibition. We used Plasmid DNA isolation and polymerase chain reaction (PCR) for the detection of Six different genes among five predominant pathogens responsible for UTI. The cnf1 gene, encoding cytotoxic necrotizing factor, was detected in seven Escherichia coli isolates n=15(46%), with a gene size of 600 bp. The VanA gene, associated with vancomycin resistance, was found in Four vancomycin-resistant enterococci (VRE) isolates n= 14(28%), with product 300 bp. The product size of Enterococcus faecalis endocardiatis antigen (efa) gene was 600bp found in Eight isolates n=10(80%). Quorum sensing genes (Las-R & Rhl-r) were identified in Pseudomonas aeruginosa isolates associated with biofilm production. The product size was 700 bp and 600bp respectively. Twenty isolates were positive from Thirty three isolates tested n=33(60%) for qouram sensing genes. The product size of algD gene coding for GDP mannose dehydrogenase in Pseudomonas aeruginosa was 1Kb. Six MRSA strains were found positive for methicillin resistance (mec A) and pantovalentine leukocidine genes (Pvl) n= 10 (60%) S.aureus isolates. Product Size of the mecA and Pvl gene was 400 and 450bp respectively.
Conclusion:
This study highlights that uropathogenic strains isolated from diabetic patients carry a variety of virulence genes that contribute to the progression and pathogenesis of UTI. Our study shows that UTI in diabetic patients are complicated by antimicrobial resistance, toxin production, adhesion mechanisms and biofilm formation. The detection of virulence genes can assist in developing better diagnostic markers for the detection of UTI pathogens.
Key words: Diabetes mellitus, Antibiotic resistance, Biofilms, Virulence, Quorum sensing
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