POS-253 THE DETECTION OF PLASMID-MEDIATED ESBLS AND PMQR GENES IN UROPATHOGENS ISOLATED FROM DIABETIC KIDNEY DISEASE PATIENTS WITH UTI

Abstract

IDF has estimated that approximately 463 million adults (20-79 years) were living with diabetes; by 2045 this will rise to 700 million. Diabetes caused 4.2 million deaths. Diabetes is one of the leading causes of chronic kidney disease (CKD). DM induces a wide range of kidney damage that can be classified as follows: diabetic nephropathy (DN), diabetic kidney disease (DKD) and non-diabetic renal disease (NDRD). The spectrum of NDRD includes kidney diseases such as IgA nephropathy, membranous nephropathy, urinary tract infections etc., that are requiring specific treatments. Urinary tract infections is the most common bacterial infections, which occur at rates 3 to 4 times more often in diabetic patients than in general population. Moreover, infection is an importаnt cause of mоrbidity and mоrtality amоng patients with kidney failurе and is the sеcond lеading causе of death following CVD. The effectiveness of treatment UTI is limited due to the antibiotic resistance development. By 2050, it is estimated that antibiotic resistance will cause 10 million deaths every year. A cross-sectional study of 105 adult patients, who were admitted in Kharkiv City Clinical Emergency Hospital, Ukraine, was carried out. The diagnosis of DKD has been stated in accordance with the criteria established by KDIGO. UTIs were diagnosed according to EAU 2020 guidelines. Antimicrobial susceptibility of bacterial isolates was determined by the Kirby Bauer disk diffusion method and screening for PMRG was performed by the polymerase chain reaction (table 1). From 105 observed patients, 21 (20 %), 28 (26.7 %), 27 (25.7 %) and 29 (27.6 %) were identified to have CKD G1, CKD G2, CKD G3 and CKD G4, respectively. The patients were hospitalized when they have following signs/symptoms: chills, rigors or warmth associated with fever; flank pain; nausea or vomiting; dysuria, urinary frequency or urinary urgency; costo-vertebral angle tenderness on physical examination. Out of 105 patients, 31 (29.5%) were infected with PMRG-producing bacteria. Among 81 gram negative bacterial isolates, 39 (48.1 %) were identified to carry different types of PMRG, among which 27 (69.2 %) were found to be extended spectrum beta-lactamases producers (ESBLs), and 12 (30.8 %) – were positive for plasmid-mediated quinolone resistance genes (PMQR), table 2. The most active antimicrobial agents against isolated strains were meropenem, nitroxolinum, fosfomycin and cefepime. Susceptibility rates of isolated uropathogens depending on expression of different types of PMRG are presenting in figure 1. According to multivariate analysis, chronic heart failure (OR 3.20; 95% CI: 1.27-8.07), coronary artery disease (OR 3.57; 95% CI: 1.42-9.02), age > 55 years (OR 3.05; 95% CI: 1.12-8.32), atrial hypertension (OR 2.57; 95% CI: 0.94-7.04), chronic kidney disease stage ІІІ (OR 2.03; 95% CI: 0.80-5.10) and stage ІV ст. (OR 1.1; 95% CI: 0.40-2.60), hospital admission (OR 2.02; 95% CI: 0.78-5.23), use of an antibiotic in the preceding year (OR 1.41; 95% CI: 0.60-3.33) were found to be associated with plasmid-mediated genes existence (figure 2). Further clinical studies are needed to establish the guideline for the management of DKD patients with resistant UTI and to expand the number of options available for empiric therapy of these multi-drug resistance infections.