Antibacterial Drugs Resistance Profile of Uropathogenic Bacteria Recovered from Hemodialysis Patients

Abstract

Background: Antimicrobial resistance (AMR) has become an emerging public health issue in recent years, particularly in uropathogenic bacteria such as Escherichia coli, Citrobacter freundii, Pseudomonas aeruginosa, Enterobacter aerogenes, and Morganella morganii. These pathogenic bacteria are a leading cause of morbidity and mortality among hemodialysis patients. This study investigated the molecular characterization and phylogenetic analysis of antibiotic-resistance genes in uropathogenic bacteria recovered from hemodialysis patients. Methods: A total of 2360 urine samples were taken from hemodialysis patients with Urinary Tract Infections (UTIs), who attended Khyber Teaching Hospital in Peshawar, Pakistan from January 2019 to December 2021. The samples were cultured and the isolates were confirmed through biochemical analysis. The antibiotic-resistant genes were amplified using PCR followed by the Sanger sequencing. Finally, phylogenetic trees were generated using Molecular Evolutionary Genetic Analysis (MEGA)-7 software. Results: Among a total of 509 (21.6%) uropathogenic isolates, Escherichia coli, Citrobacter freundii, Morganella morganii, Enterobacter aerogenes and Pseudomonas aeruginosa were reported as 54%, 17.5%, 11.78%, 10.6% and 6.0%, respectively. The genetic analysis revealed that bla-_CTXM was the most prevalent gene then, bla-_SHV and bla-_VIM among uropathogenic bacteria. Most of the isolates were resistant to Ciprofloxacin, Ampicillin, Cefotaxime, Ceftazidime, Amoxicillin, Cefepime, Aztreonam, Doxycycline and Trimethoprim. Minimum inhibitory concentrations (MICs) ranged from 64 to >256 ug/mL. Point mutations were observed in the sequence of the bla-_VIM gene at positions 240 (C-T), 295 (G-A), and 293 (A-G). The phylogenetic tree predicated that the bla-_CTXM gene is 99% closely related to Escherichia coli, Citrobacter, and Enterococci strains, whereas the bla-_TEM gene is 99% similar to Escherichia coli strain and Enterobacter species. Conclusions: Antibiotics such as Tigecycline, Meropenem, Fosfomycin, Nitrofurantoin and Amikacin may be promising treatment options against MDR ESBL-producing uropathogenic bacteria. These drugs may be the first-line option against uropathogenic bacteria resistant to Cephalosporins, Ciprofloxacin, and Gentamycin from this region.