Prevalence of Beta-Lactamase Producing Genes in Escherichia Coli Isolated from Diabetic Foot Ulcers: A Hospital Based Study from South-Western Maharashtra
Keywords:
Diabetic foot ulcer, E.coli, ESBL, MBL, NDM, TEM, VIM
Abstract
The antibiotic resistance in the bacteria inhabiting diabetic foot ulcers (DFU) is a major hurdle during medical treatment. Extended-spectrum beta-lactamase (ESBL) and Metallo-beta-lactamase (MBL) production in bacteria is one of the most prevalent beta lactam antibiotic resistance mechanisms. Resent literature suggested that E. coli is one of most abundant Gram negative bacteria found in DFUs. We studied the antibiotic resistance and the prevalence of the genes involved in beta lactamase production in theE. coli isolated from the DFU patients in Maharashtra, India. We isolated a total of 91 E. coli isolates from the diabetic patients and subjected to varies biochemical tests including ESBL and MBL tests. Antibiotic resistance in all the isolates was tested using Ampicillin, Amoxicillin, Piperacillin, Cefuroxime, Ceftriaxone, Cefoperazone, Cefepime, Imipenem, Meropenem, Amikacin, Gentamicine, and Ciprofloxacin. The presence of TEMESBL, SHVESBL, CTX-MESBL,NDM-1bla, KPCbla, OXA-48bla, and VIMbla genes was evaluated by using specific primers and PCR. Among isolates 56.04% were positive for ESBL production and 48.35% were positive for MBL production. All the isolates showed varying degree of resistance towards antibiotics used. More than 50% isolates were vulnerable to carbapenem and aminoglycoside antibiotics. Genetic analysis revealed that NDM-1bla is the most prevalent gene is the E. coli isolates followed by TEMESBL, CTX-MESBL, and KPCbla.VIMbla is the least abundant gene found in the E. coli isolates. The results suggest that all E. coli isolates were multi-drug resistant. There was no association between the presence of a particular gene and antibiotic resistance in the isolates. Further studies considering all bacterial isolates from DFUs for antibacterial resistance and genetic characterization are necessary to understand the genetic basis of resistance.
References
[1] Pradeepa R, Mohan V. Epidemiology of type 2 diabetes in India. Ind J Ophthalmol 2021; 69: 2932. https://doi.org/10.4103/ijo.IJO_1627_21.
[2] Reed J, Bain S, Kanamarlapudi V. A Review of Current Trends with Type 2 Diabetes Epidemiology, Aetiology, Pathogenesis, Treatments and Future Perspectives. Diabetes Metab Syndr Obes. 2021; 14: 3567–3602.
[3] https://doi.org/10.2147/DMSO.S319895.
[4] Noor S, Zubair M, Ahmad J. Diabetic foot ulcer—A review on pathophysiology, classification and microbial etiology. Diabetes & Metabolic Syndrome: Clin Res Rev. 2015; 9: 192–199. https://doi.org/10.1016/j.dsx.2015.04.007.
[5] Mancuso G, Midiri A, Gerace E, Biondo C. Bacterial Antibiotic Resistance: The Most Critical Pathogens. Pathogens 2021; 10: 1310.
[6] https://doi.org/10.3390/pathogens10101310.
[7] Peterson E, Kaur P. Antibiotic Resistance Mechanisms in Bacteria: Relationships Between Resistance Determinants of Antibiotic Producers, Environmental Bacteria, and Clinical Pathogens. Front Microbiol. 2018; 9: 2928.
[8] https://doi.org/10.3389/fmicb.2018.02928.
[9] Reygaert W. An overview of the antimicrobial resistance mechanisms of bacteria. AIMS Microbiol. 2018; 4: 482–501. https://doi.org/10.3934/microbiol.2018.3.482
[10] Wright GD. The antibiotic resistome: the nexus of chemical and genetic diversity. Nat Rev Microbiol. 2007; 5: 175–186. https://doi.org/10.1038/nrmicro1614.
[11] Canton R, Coque TM. The CTX-M β-lactamase pandemic. Cur Opinion Microbiol. 2006; 9: 466–475. https://doi.org/10.1016/j.mib.2006.08.011.
[12] Humeniuk C, Arlet G, Gautier V, Grimont P, Labia R, Philippon A. β-Lactamases of Kluyveraascorbata , Probable Progenitors of Some Plasmid-Encoded CTX-M Types. Antimicrob Agents Chemother 2002; 46: 3045–3049.
[13] Castanheira M, Simner PJ, Bradford PA. Extended-spectrum β -lactamases: an update on their characteristics, epidemiology and detection. JAC-Antimicrobial Resistance. 2021; 3: dlab092. https://doi.org/10.1093/jacamr/dlab092.
[14] Boyd SE, Livermore DM, Hooper DC, Hope WW. Metallo-β-Lactamases: Structure, Function, Epidemiology, Treatment Options, and the Development Pipeline. Antimicrob Agents Chemother 2020; 64: e00397-20. https://doi.org/10.1128/AAC.00397-20
[15] Meletis G. Carbapenem resistance: overview of the problem and future perspectives. Ther Adv Inf 2016; 3: 15–21. https://doi.org/10.1177/2049936115621709.
[16] Sultana R. Ahmed I, Saima S, Salam MT, Sultana S. Diabetic foot ulcer-a systematic review on relevant microbial etiology and antibiotic resistance in Asian countries. Diabetes Metab Syndrome: Clin Res Rev 2023; 17: 102783.
[17] Shankhdhar K, Shankhdhar LK, Shankhdhar U, Shankhdhar S. Diabetic foot problems in India: An overview and potential simple approaches in a developing country. Curr Diab Rep. 2008; 8:452–457. https://doi.org/10.1007/s11892-008-0078-y
[18] Singh N. Preventing Foot Ulcers in Patients with Diabetes. JAMA 2005; 293:217. https://doi.org/10.1001/jama.293.2.217.
[19] Kale D, Karande G, Datkhil, K. Diabetic foot ulcer in India: Aetiological trends and bacterial diversity. Indian J Endocr Metab 2023; 27: 107. https://doi.org/10.4103/ijem.ijem_458_22.
[20] Jain S, Barman R. Bacteriological profile of diabetic foot ulcer with special reference to drug-resistant strains in a tertiary care center in North-East India.Indian J Endocr Metab. 2017; 21: 688. https://doi.org/10.4103/ijem.IJEM_546_16
[21] Rastogi A, Sukumar S, Hajela A, Mukherjee S, Dutta P, Bhadada SK, Bhansali A. The microbiology of diabetic foot infections in patients recently treated with antibiotic therapy: A prospective study from India. J Diabetes Complications. 2017; 31: 407–412. https://doi.org/10.1016/j.jdiacomp.2016.11.001.
[22] Shahi SK, Kumar A. Isolation and Genetic Analysis of Multidrug Resistant Bacteria from Diabetic Foot Ulcers. Front Microbiol. 2016; 6:
[23] https://doi.org/10.3389/fmicb.2015.01464.
[24] Zubair M, Ahmad J. Potential risk factors and outcomes of infection with multidrug resistance among diabetic patients having ulcers: 7 years study. Diabetes Metab Syndrome: Clin Res Rev 2019; 13: 414–418.
[25] https://doi.org/10.1016/j.dsx.2018.10.014.
[26] Bajpai T, Pandey M, Varma M, Bhatambare G S. Prevalence of TEM, SHV, and CTX-M Beta-Lactamase genes in the urinary isolates of a tertiary care hospital. Avicenna J Med 2017; 07: 12–16. https://doi.org/10.4103/2231-0770.197508.
[27] Sahoo S, Otta S, Swain B, Kar SK. Detection and genetic characterization of extended-spectrum beta-lactamases producers in a tertiary care hospital. J Lab Physicians. 2019; 11: 253–258. https://doi.org/10.4103/JLP.JLP_31_19.
[28] Galani I, Rekatsina PD, Hatzaki D, Plachouras D, Souli M, Giamarellou H. Evaluation of different laboratory tests for the detection of metallo- -lactamase production in Enterobacteriaceae. J Antimicrob Chemotherapy. 2008; 61: 548–553. https://doi.org/10.1093/jac/dkm535
[29] Yong D, Lee K, Yum JH, Shin HB, Rossolini GM, Chong Y. Imipenem-EDTA Disk Method for Differentiation of Metallo-β-Lactamase-Producing Clinical Isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol. 2002; 40:3798–3801. https://doi.org/10.1128/JCM.40.10.3798-3801.2002
[30] Blair WF. Mating Call in the Speciation of Anuran Amphibians. American Naturalist. 1958; 92: 27–51. https://doi.org/10.1086/282007.
[31] Martinez JL. General principles of antibiotic resistance in bacteria. Drug Discovery Today: Technologies. 2014; 11: 33–39. https://doi.org/10.1016/j.ddtec.2014.02.001
[32] Appapalam S, Muniyan A, Vasanthi Mohan K, Panchamoorthy R. 2021. A Study on Isolation, Characterization, and Exploration of Multiantibiotic-Resistant Bacteria in the Wound Site of Diabetic Foot Ulcer Patients. Int J Lower Extrem Wound. 2021; 20: 6–14. https://doi.org/10.1177/1534734619884430.
[33] Dawaiwala I, Awaghade S, Kolhatkar P, Pawar S, Barsode S. Microbiological Pattern, Antimicrobial Resistance and Prevalence of MDR/XDR Organisms in Patients With Diabetic Foot Infection in an Indian Tertiary Care Hospital. Int J Lower Extren Wounnds. 2021; 153473462110380.
[34] https://doi.org/10.1177/15347346211038090
[35] Si Z, Pethe K, Chan-Park MB. Chemical Basis of Combination Therapy to Combat Antibiotic Resistance. JACS Au. 2023; 3: 276–292.
[36] https://doi.org/10.1021/jacsau.2c00532.
[37] Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, Chaudhary U, Doumith M, Giske CG, Irfan S, Krishnan P, Kumar AV, Maharjan S, Mushtaq S, Noorie T, Paterson DL, Pearson A, Perry C, Pike R, Rao B, Ray U, Sarma JB, Sharma M, Sheridan E, Thirunarayan MA, Turton J, Upadhyay S, Warner M, Welfare W, Livermore DM, Woodford N. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. The Lancet Infectious Diseases. 2010; 10: 597–602. https://doi.org/10.1016/S1473-3099 (10)70143-2.
[38] Shahi SK, Singh VK, Kumar A. Detection of Escherichia coli and Associated β-Lactamases Genes from Diabetic Foot Ulcers by Multiplex PCR and Molecular Modeling and Docking of SHV-1, TEM-1, and OXA-1 β-Lactamases with Clindamycin and Piperacillin-Tazobactam. PLoS ONE. 2013; 8: e68234. https://doi.org/10.1371/journal.pone.0068234.https://doi.org/10.1016/j.dsx.2023.102783.
[39] Chaudhry WN, Badar R, Jamal M, Jeong J, Zafar J, Andleeb S. Clinico-microbiological study and antibiotic resistance profile of mecA and ESBL gene prevalence in patients with diabetic foot infections. Experiment Ther Med. 2016;11: 1031–1038. https://doi.org/10.3892/etm.2016.2996
[40] Govindaswamy A, Bajpai V, Khurana S, Aravinda A, Batra P, Malhotra R, Mathur P. Prevalence and characterization of beta-lactamase-producing Escherichia coli isolates from a tertiary care hospital in India. J Lab Physicians. 2019; 11: 123–127. https://doi.org/10.4103/JLP.JLP_122_18
[41] Gupta V, Singh M, Datta P, Goel A, Singh S, Prasad ., Chander J. Detection of Various Beta-Lactamases in Escherichia coli and Klebsiella sp.: A Study from Tertiary Care Centre of North India. Ind J Med Microbiol. 2020; 38: 390–396. https://doi.org/10.4103/ijmm.IJMM_20_253
[42] Jaggi N, Chatterjee N, Singh V, Giri SK, Dwivedi P, Panwar R, Sharma AP. Carbapenem resistance in Escherichia coli and Klebsiella pneumoniae among Indian and international patients in North India. A Micr. 2019; 66: 367–376. https://doi.org/10.1556/030.66.2019.020
[43] Khajuria A. Emergence of Escherichia coli, Co-Producing NDM-1 and OXA-48 Carbapenemases, in Urinary Isolates, at a Tertiary Care Centre at Central India. J Clin Diagn Res. 2014; 8 (6): DC01-DC04. https://doi.org/10.7860/JCDR/2014/7952.4413
[44] Nagaraj S, Chandran S, Shamanna P, Macaden R.Carbapenem resistance among Escherichia coli and Klebsiellapneumoniae in a tertiary care hospital in south India. Ind J Med Microbiol. 2012; 30: 93–95. https://doi.org/10.4103/0255-0857.93054.
[45] Saseedharan S, Sahu M, Chaddha R, Pathrose E, Bal A, Bhalekar P, Sekar P, Krishnan P. Epidemiology of diabetic foot infections in a reference tertiary hospital in India. Braz J Microbiol. 2018; 49: 401-406. https://doi.org/10.1016/j.bjm.2017.09.003
[46] Rahman M, Mukhopadhyay C, Rai RP, Singh S, Gupta S, Singh A, Pathak A, Prasad KN. Novel variant NDM-11 and other NDM-1 variants in multidrug-resistant Escherichia coli from South India. J Glob Antimicrob Resist. 2018; 14: 154–157. https://doi.org/10.1016/j.jgar.2018.04.001.
[47] Wall IB, Davies CE, Hill KE, Wilson MJ, Stephens P, Harding KG, Thomas DW. Potential role of anaerobic cocci in impaired human wound healing. Wound Repair Regen 2002; 10:346–353. https://doi.org/10.1046/j.1524-475X.2002.t01-1-10602.x.
[48] Orazi G, O’Toole GA. “It Takes a Village”: Mechanisms Underlying Antimicrobial Recalcitrance of Polymicrobial Biofilms. J Bacteriol. 2019; 202: https://doi.org/10.1128/JB.00530-19.
[49] James GA, Swogger E, Wolcott R, Pulcini E deLancey Secor P, Sestrich J, Costerton JW, Stewart PS. Biofilms in chronic wounds. Wound Repair and Regeneration. 2008; 16: 37–44. https://doi.org/10.1111/j.1524-475X.2007.00321.x
[50] Mah TFC, O’Toole GA. Mechanisms of biofilm resistance to antimicrobial agents. Trends in Microbiol. 2001; 9: 34–39. https://doi.org/10.1016/S0966-842X(00)01913-2
[2] Reed J, Bain S, Kanamarlapudi V. A Review of Current Trends with Type 2 Diabetes Epidemiology, Aetiology, Pathogenesis, Treatments and Future Perspectives. Diabetes Metab Syndr Obes. 2021; 14: 3567–3602.
[3] https://doi.org/10.2147/DMSO.S319895.
[4] Noor S, Zubair M, Ahmad J. Diabetic foot ulcer—A review on pathophysiology, classification and microbial etiology. Diabetes & Metabolic Syndrome: Clin Res Rev. 2015; 9: 192–199. https://doi.org/10.1016/j.dsx.2015.04.007.
[5] Mancuso G, Midiri A, Gerace E, Biondo C. Bacterial Antibiotic Resistance: The Most Critical Pathogens. Pathogens 2021; 10: 1310.
[6] https://doi.org/10.3390/pathogens10101310.
[7] Peterson E, Kaur P. Antibiotic Resistance Mechanisms in Bacteria: Relationships Between Resistance Determinants of Antibiotic Producers, Environmental Bacteria, and Clinical Pathogens. Front Microbiol. 2018; 9: 2928.
[8] https://doi.org/10.3389/fmicb.2018.02928.
[9] Reygaert W. An overview of the antimicrobial resistance mechanisms of bacteria. AIMS Microbiol. 2018; 4: 482–501. https://doi.org/10.3934/microbiol.2018.3.482
[10] Wright GD. The antibiotic resistome: the nexus of chemical and genetic diversity. Nat Rev Microbiol. 2007; 5: 175–186. https://doi.org/10.1038/nrmicro1614.
[11] Canton R, Coque TM. The CTX-M β-lactamase pandemic. Cur Opinion Microbiol. 2006; 9: 466–475. https://doi.org/10.1016/j.mib.2006.08.011.
[12] Humeniuk C, Arlet G, Gautier V, Grimont P, Labia R, Philippon A. β-Lactamases of Kluyveraascorbata , Probable Progenitors of Some Plasmid-Encoded CTX-M Types. Antimicrob Agents Chemother 2002; 46: 3045–3049.
[13] Castanheira M, Simner PJ, Bradford PA. Extended-spectrum β -lactamases: an update on their characteristics, epidemiology and detection. JAC-Antimicrobial Resistance. 2021; 3: dlab092. https://doi.org/10.1093/jacamr/dlab092.
[14] Boyd SE, Livermore DM, Hooper DC, Hope WW. Metallo-β-Lactamases: Structure, Function, Epidemiology, Treatment Options, and the Development Pipeline. Antimicrob Agents Chemother 2020; 64: e00397-20. https://doi.org/10.1128/AAC.00397-20
[15] Meletis G. Carbapenem resistance: overview of the problem and future perspectives. Ther Adv Inf 2016; 3: 15–21. https://doi.org/10.1177/2049936115621709.
[16] Sultana R. Ahmed I, Saima S, Salam MT, Sultana S. Diabetic foot ulcer-a systematic review on relevant microbial etiology and antibiotic resistance in Asian countries. Diabetes Metab Syndrome: Clin Res Rev 2023; 17: 102783.
[17] Shankhdhar K, Shankhdhar LK, Shankhdhar U, Shankhdhar S. Diabetic foot problems in India: An overview and potential simple approaches in a developing country. Curr Diab Rep. 2008; 8:452–457. https://doi.org/10.1007/s11892-008-0078-y
[18] Singh N. Preventing Foot Ulcers in Patients with Diabetes. JAMA 2005; 293:217. https://doi.org/10.1001/jama.293.2.217.
[19] Kale D, Karande G, Datkhil, K. Diabetic foot ulcer in India: Aetiological trends and bacterial diversity. Indian J Endocr Metab 2023; 27: 107. https://doi.org/10.4103/ijem.ijem_458_22.
[20] Jain S, Barman R. Bacteriological profile of diabetic foot ulcer with special reference to drug-resistant strains in a tertiary care center in North-East India.Indian J Endocr Metab. 2017; 21: 688. https://doi.org/10.4103/ijem.IJEM_546_16
[21] Rastogi A, Sukumar S, Hajela A, Mukherjee S, Dutta P, Bhadada SK, Bhansali A. The microbiology of diabetic foot infections in patients recently treated with antibiotic therapy: A prospective study from India. J Diabetes Complications. 2017; 31: 407–412. https://doi.org/10.1016/j.jdiacomp.2016.11.001.
[22] Shahi SK, Kumar A. Isolation and Genetic Analysis of Multidrug Resistant Bacteria from Diabetic Foot Ulcers. Front Microbiol. 2016; 6:
[23] https://doi.org/10.3389/fmicb.2015.01464.
[24] Zubair M, Ahmad J. Potential risk factors and outcomes of infection with multidrug resistance among diabetic patients having ulcers: 7 years study. Diabetes Metab Syndrome: Clin Res Rev 2019; 13: 414–418.
[25] https://doi.org/10.1016/j.dsx.2018.10.014.
[26] Bajpai T, Pandey M, Varma M, Bhatambare G S. Prevalence of TEM, SHV, and CTX-M Beta-Lactamase genes in the urinary isolates of a tertiary care hospital. Avicenna J Med 2017; 07: 12–16. https://doi.org/10.4103/2231-0770.197508.
[27] Sahoo S, Otta S, Swain B, Kar SK. Detection and genetic characterization of extended-spectrum beta-lactamases producers in a tertiary care hospital. J Lab Physicians. 2019; 11: 253–258. https://doi.org/10.4103/JLP.JLP_31_19.
[28] Galani I, Rekatsina PD, Hatzaki D, Plachouras D, Souli M, Giamarellou H. Evaluation of different laboratory tests for the detection of metallo- -lactamase production in Enterobacteriaceae. J Antimicrob Chemotherapy. 2008; 61: 548–553. https://doi.org/10.1093/jac/dkm535
[29] Yong D, Lee K, Yum JH, Shin HB, Rossolini GM, Chong Y. Imipenem-EDTA Disk Method for Differentiation of Metallo-β-Lactamase-Producing Clinical Isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol. 2002; 40:3798–3801. https://doi.org/10.1128/JCM.40.10.3798-3801.2002
[30] Blair WF. Mating Call in the Speciation of Anuran Amphibians. American Naturalist. 1958; 92: 27–51. https://doi.org/10.1086/282007.
[31] Martinez JL. General principles of antibiotic resistance in bacteria. Drug Discovery Today: Technologies. 2014; 11: 33–39. https://doi.org/10.1016/j.ddtec.2014.02.001
[32] Appapalam S, Muniyan A, Vasanthi Mohan K, Panchamoorthy R. 2021. A Study on Isolation, Characterization, and Exploration of Multiantibiotic-Resistant Bacteria in the Wound Site of Diabetic Foot Ulcer Patients. Int J Lower Extrem Wound. 2021; 20: 6–14. https://doi.org/10.1177/1534734619884430.
[33] Dawaiwala I, Awaghade S, Kolhatkar P, Pawar S, Barsode S. Microbiological Pattern, Antimicrobial Resistance and Prevalence of MDR/XDR Organisms in Patients With Diabetic Foot Infection in an Indian Tertiary Care Hospital. Int J Lower Extren Wounnds. 2021; 153473462110380.
[34] https://doi.org/10.1177/15347346211038090
[35] Si Z, Pethe K, Chan-Park MB. Chemical Basis of Combination Therapy to Combat Antibiotic Resistance. JACS Au. 2023; 3: 276–292.
[36] https://doi.org/10.1021/jacsau.2c00532.
[37] Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, Chaudhary U, Doumith M, Giske CG, Irfan S, Krishnan P, Kumar AV, Maharjan S, Mushtaq S, Noorie T, Paterson DL, Pearson A, Perry C, Pike R, Rao B, Ray U, Sarma JB, Sharma M, Sheridan E, Thirunarayan MA, Turton J, Upadhyay S, Warner M, Welfare W, Livermore DM, Woodford N. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. The Lancet Infectious Diseases. 2010; 10: 597–602. https://doi.org/10.1016/S1473-3099 (10)70143-2.
[38] Shahi SK, Singh VK, Kumar A. Detection of Escherichia coli and Associated β-Lactamases Genes from Diabetic Foot Ulcers by Multiplex PCR and Molecular Modeling and Docking of SHV-1, TEM-1, and OXA-1 β-Lactamases with Clindamycin and Piperacillin-Tazobactam. PLoS ONE. 2013; 8: e68234. https://doi.org/10.1371/journal.pone.0068234.https://doi.org/10.1016/j.dsx.2023.102783.
[39] Chaudhry WN, Badar R, Jamal M, Jeong J, Zafar J, Andleeb S. Clinico-microbiological study and antibiotic resistance profile of mecA and ESBL gene prevalence in patients with diabetic foot infections. Experiment Ther Med. 2016;11: 1031–1038. https://doi.org/10.3892/etm.2016.2996
[40] Govindaswamy A, Bajpai V, Khurana S, Aravinda A, Batra P, Malhotra R, Mathur P. Prevalence and characterization of beta-lactamase-producing Escherichia coli isolates from a tertiary care hospital in India. J Lab Physicians. 2019; 11: 123–127. https://doi.org/10.4103/JLP.JLP_122_18
[41] Gupta V, Singh M, Datta P, Goel A, Singh S, Prasad ., Chander J. Detection of Various Beta-Lactamases in Escherichia coli and Klebsiella sp.: A Study from Tertiary Care Centre of North India. Ind J Med Microbiol. 2020; 38: 390–396. https://doi.org/10.4103/ijmm.IJMM_20_253
[42] Jaggi N, Chatterjee N, Singh V, Giri SK, Dwivedi P, Panwar R, Sharma AP. Carbapenem resistance in Escherichia coli and Klebsiella pneumoniae among Indian and international patients in North India. A Micr. 2019; 66: 367–376. https://doi.org/10.1556/030.66.2019.020
[43] Khajuria A. Emergence of Escherichia coli, Co-Producing NDM-1 and OXA-48 Carbapenemases, in Urinary Isolates, at a Tertiary Care Centre at Central India. J Clin Diagn Res. 2014; 8 (6): DC01-DC04. https://doi.org/10.7860/JCDR/2014/7952.4413
[44] Nagaraj S, Chandran S, Shamanna P, Macaden R.Carbapenem resistance among Escherichia coli and Klebsiellapneumoniae in a tertiary care hospital in south India. Ind J Med Microbiol. 2012; 30: 93–95. https://doi.org/10.4103/0255-0857.93054.
[45] Saseedharan S, Sahu M, Chaddha R, Pathrose E, Bal A, Bhalekar P, Sekar P, Krishnan P. Epidemiology of diabetic foot infections in a reference tertiary hospital in India. Braz J Microbiol. 2018; 49: 401-406. https://doi.org/10.1016/j.bjm.2017.09.003
[46] Rahman M, Mukhopadhyay C, Rai RP, Singh S, Gupta S, Singh A, Pathak A, Prasad KN. Novel variant NDM-11 and other NDM-1 variants in multidrug-resistant Escherichia coli from South India. J Glob Antimicrob Resist. 2018; 14: 154–157. https://doi.org/10.1016/j.jgar.2018.04.001.
[47] Wall IB, Davies CE, Hill KE, Wilson MJ, Stephens P, Harding KG, Thomas DW. Potential role of anaerobic cocci in impaired human wound healing. Wound Repair Regen 2002; 10:346–353. https://doi.org/10.1046/j.1524-475X.2002.t01-1-10602.x.
[48] Orazi G, O’Toole GA. “It Takes a Village”: Mechanisms Underlying Antimicrobial Recalcitrance of Polymicrobial Biofilms. J Bacteriol. 2019; 202: https://doi.org/10.1128/JB.00530-19.
[49] James GA, Swogger E, Wolcott R, Pulcini E deLancey Secor P, Sestrich J, Costerton JW, Stewart PS. Biofilms in chronic wounds. Wound Repair and Regeneration. 2008; 16: 37–44. https://doi.org/10.1111/j.1524-475X.2007.00321.x
[50] Mah TFC, O’Toole GA. Mechanisms of biofilm resistance to antimicrobial agents. Trends in Microbiol. 2001; 9: 34–39. https://doi.org/10.1016/S0966-842X(00)01913-2
Published
2024-01-03
How to Cite
Dipak S. Kale. (2024). Prevalence of Beta-Lactamase Producing Genes in Escherichia Coli Isolated from Diabetic Foot Ulcers: A Hospital Based Study from South-Western Maharashtra. Revista Electronica De Veterinaria, 25(1), 355 - 367. Retrieved from https://www.veterinaria.org/index.php/REDVET/article/view/525
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