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Antimicrobial resistance profiles and detection of mecA, blaCTX-M-1, and blaSHV genes in bacteria among diabetic foot ulcer patients from selected referral hospitals in Uganda
Author: Alice Namatovu, Bienfait Mumbere Vahwere, Ibrahim Ntulume, Robinson Ssebuufu, Rebecca Nalubega, Theophilus Pius, Franck K. Sikakulya, Gidio Agaba, Emmanuel Seremba, Patrick Kyamanywa and George William Nasinyama
Publisher: BMC Infectious Diseases
Published: 2025
Section: Faculty of Clinical Medicine and Dentistry
Abstract
Background Effective management of Diabetic foot ulcers (DFU) requires timely treatment of infections with
appropriate antibiotics based on culture and susceptibility results. However, challenges in diagnostic testing persist
and consequently, data on prevalent bacteria, their antimicrobial resistance profiles and genes remains scanty. This
study profiled the prevalent bacteria in Diabetic foot infection (DFI), their antimicrobial susceptibility patterns, and
associated resistance genes.
Methodology A multi-center cross sectional study was conducted from November 2021-January 2022, involving
117 patients with DFU, attending selected referral hospitals (Kiruddu, Jinja, Kampala International Teaching Hospital,
Kitagata, Mbarara, Fort Portal and Hoima). Wound swabs were aseptically collected and placed in Stuart transport
medium, then pre-enriched prior to inoculation onto Blood, MacConkey and Chocolate Agar to isolate aerobic
microorganisms. Bacteria identification was based on colony morphology, Gram stain, conventional biochemical tests
and Antibiotic susceptibility testing using Kirby-Bauer disk diffusion method were performed. Methicillin-resistant
Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) were
identified phenotypically. mecA gene in selected MRSA, and blaCTX-M-1 and blaSHV-1 in ESBL-PE were detected
using Uniplex PCR and electrophoresed using 1.5% agarose gel. Data was analyzed using MS Excel version 15 and
Stata version 15 (Stata Corp®).
Results Microbiologically confirmed infection was observed in 89.7% (105/117) of DFU cases, yielding 144 bacterial
isolates. Poly-microbial infections were detected in 23.8% of patients. Gram-positive bacteria accounted for 55.6%
(80/144) of isolates. Staphylococcus aureus (36.1% (52/144)) and Proteus spp (13.9% (20/144)) were the most prevalent
Gram-positive and Gram-negative bacteria, respectively. Notably, 98.6% (142/144) of the isolates were multidrug
resistant organisms (MDR). Staphylococcus aureus sensitivity was highest for Gentamycin and Ciprofloxacin (48%