Virulence Factors of Uropathogenic Escherichia coli in Diabetic Patients of Al-Muthanna Province

Abstract

Background and aims: There are evidences that patients with diabetes have an increased risk of asymptomatic bacteriuria and urinary tract infections (UTIs). UTIs are the most common bacterial infection in diabetic patients. The present study aimed to describe the characteristics of E. coli of Al-Muthanna province patients with urinary tract infection by identifying the virulence genes (FimH, Pap and HlyA). Material and methods: The study population included 240 diabetic and non-diabetic patients with UTIs as well the healthy control, Urine and blood sample was collected at Al Hussein Educational Hospital, between October 2017 to July 2018. Serum sample were collected and stored for immunological tests. Standard protocol was followed to isolate and identify organism and the data were analyzed using Microsoft Excel 2013. Results: Of the total 240, The results  of the study  were  41 (33.3%)  isolates  of  Diabetes  patients (DM group), 42(34.1%) isolates of Non-Diabetes  patients (ND group) with  urinary pathogenic  E. coli (UPEC)  and selected 40 (32.5%) of control group.  The age  duration of  46-61  years  were  most prevalence  of  UPEC  infections either  DM group  (56.1%) or  ND group (35.7%)  while  the gender  factor was shown significantly in DM and ND females (78.1% and 97.6% respectively ) compare to  males.  Twenty two  (53.7%) of diabetes urban  community  were  found to have UPEC infections while the rural infected  population were 19 (46.3%),  Non-diabetes  group  were recoded  17 (40.5%) , 25 (59.5%) positive cases of UPEC in urban  and rural  communities respectively. Fimbriae  severity virulence  genes of  DNA (fimH , pap) and  alpha-hemolysis  gene (HlyA)  of  were  extracted  of  83  UPEC isolates,  it was  then  identified  using the PCR amplification technique. The results  of molecular  diagnosis  shown that fimH was  detected  in  78%  in DM  patients  had  higher  than of  ND  patients (57%) of UPEC strains while the  percent of  Pap and HlyA were (31.7%, 12.2%) in DM patients compare to  ND patients  (Pap /38.1%)  and  (HlyA /7.1%)  of  UPEC  strains  respectively. Conclusion: UTIs are frequent in diabetic patients. For the reason of the great proportion of asymptomatic forms among diabetic patients, the urine culture should be performed in all hospitalized patients with diabetes.