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Peer-reviewedCC BYFrontiers in cellular and infection microbiology

Molecular epidemiology of carbapenemase-producing gram-negative bacilli in diabetic foot infections: association with glycemic control.

  • Gamal Othman1
  • Abdelnaser A Badawy2
  • Rasha Hamed Al-Serwi3
  • Maysaa El Sayed Zaki4
  • Noha Tharwat Abou El-Khier5
  • Nashwa M Alkassaby5
  • Mohamed Saleh Ismail4
5 affiliations
  1. 1Department of Basic Medical Sciences, College of Medicine, AlMaarefa University, Riyadh, Saudi Arabia.
  2. 2Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia.
  3. 3Department of Basic Dental Sciences, College of Dentistry, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
  4. 4Clinical Pathology-Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
  5. 5Medical Microbiology and Immunology- Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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Abstract

Background

Carbapenem-resistant Gram-negative bacilli are an increasing threat in diabetic foot ulcer (DFU) infections, limiting therapeutic options and worsening outcomes. However, data linking specific carbapenemase genes to clinical and metabolic factors remain limited.Objectives

To isolate Gram-negative bacilli from deep tissue biopsies of DFUs, determine carbapenem susceptibility by minimum inhibitory concentration (MIC) testing, detect major carbapenemase genes by multiplex qPCR, and evaluate their association with glycemic control and Wagner grade.Methods

This cross-sectional study included 150 patients with infected DFUs. Isolates recovered from tissue and other specimens were identified by standard microbiological methods, and carbapenem susceptibility was assessed by MIC testing. Multiplex qPCR was used to detect blaKPC, blaNDM, blaOXA-48, blaVIM, and blaIMP, and associations between resistance determinants and clinical variables were analyzed statistically.Results

The mean patient age was 56.4 ± 9.8 years, with a male predominance (61.3%), and high-grade ulcers (Wagner III-V) were present in 54.7% of patients. Klebsiella pneumoniae predominated (60.0%), followed by Pseudomonas aeruginosa and Escherichia coli (each 14.7%). Resistance to meropenem and imipenem was high (77.3% and 75.3%, respectively), and carbapenemase production was detected in 84.0% of isolates. blaKPC (28.0%) and blaNDM (24.0%) were the most prevalent genes and were significantly associated with phenotypic carbapenemase production (P = 0.002 and P = 0.006, respectively). Carbapenemase producers showed significantly higher fasting glucose and HbA1c levels than non-producers (P < 0.001), with no significant association observed for Wagner grade (P = 0.570).Conclusions

DFUs showed a high burden of carbapenemase-producing Gram-negative bacilli, driven mainly by blaKPC and blaNDM. Poor glycemic control was strongly associated with these resistant infections, underscoring the need for integrated metabolic management, molecular surveillance, and antimicrobial stewardship. These findings position glycemic control as a modifiable driver of antimicrobial resistance in DFUs.

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Cite

BibTeXRIS
BibTeX
@article{othman2026molecular,
  title = {{Molecular epidemiology of carbapenemase-producing gram-negative bacilli in diabetic foot infections: association with glycemic control.}},
  author = {Gamal Othman and Abdelnaser A Badawy and Rasha Hamed Al-Serwi and Maysaa El Sayed Zaki and Noha Tharwat Abou El-Khier and Nashwa M Alkassaby and Mohamed Saleh Ismail},
  journal = {Frontiers in cellular and infection microbiology},
  year = {2026},
  month = oct,
  doi = {10.3389/fcimb.2026.1847743},
  url = {https://europepmc.org/article/MED/42898163},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Molecular epidemiology of carbapenemase-producing gram-negative bacilli in diabetic foot infections: association with glycemic control.
AU  - Gamal Othman
AU  - Abdelnaser A Badawy
AU  - Rasha Hamed Al-Serwi
AU  - Maysaa El Sayed Zaki
AU  - Noha Tharwat Abou El-Khier
AU  - Nashwa M Alkassaby
AU  - Mohamed Saleh Ismail
PY  - 2026
DA  - 2026/10/05
JO  - Frontiers in cellular and infection microbiology
DO  - 10.3389/fcimb.2026.1847743
UR  - https://europepmc.org/article/MED/42898163
AB  - Background  Carbapenem-resistant Gram-negative bacilli are an increasing threat in diabetic foot ulcer (DFU) infections, limiting therapeutic options and worsening outcomes. However, data linking specific carbapenemase genes to clinical and metabolic factors remain limited.Objectives  To isolate Gram-negative bacilli from deep tissue biopsies of DFUs, determine carbapenem susceptibility by minimum inhibitory concentration (MIC) testing, detect major carbapenemase genes by multiplex qPCR, and evaluate their association with glycemic control and Wagner grade.Methods  This cross-sectional study included 150 patients with infected DFUs. Isolates recovered from tissue and other specimens were identified by standard microbiological methods, and carbapenem susceptibility was assessed by MIC testing. Multiplex qPCR was used to detect blaKPC, blaNDM, blaOXA-48, blaVIM, and blaIMP, and associations between resistance determinants and clinical variables were analyzed statistically.Results  The mean patient age was 56.4 ± 9.8 years, with a male predominance (61.3%), and high-grade ulcers (Wagner III-V) were present in 54.7% of patients. Klebsiella pneumoniae predominated (60.0%), followed by Pseudomonas aeruginosa and Escherichia coli (each 14.7%). Resistance to meropenem and imipenem was high (77.3% and 75.3%, respectively), and carbapenemase production was detected in 84.0% of isolates. blaKPC (28.0%) and blaNDM (24.0%) were the most prevalent genes and were significantly associated with phenotypic carbapenemase production (P = 0.002 and P = 0.006, respectively). Carbapenemase producers showed significantly higher fasting glucose and HbA1c levels than non-producers (P < 0.001), with no significant association observed for Wagner grade (P = 0.570).Conclusions  DFUs showed a high burden of carbapenemase-producing Gram-negative bacilli, driven mainly by blaKPC and blaNDM. Poor glycemic control was strongly associated with these resistant infections, underscoring the need for integrated metabolic management, molecular surveillance, and antimicrobial stewardship. These findings position glycemic control as a modifiable driver of antimicrobial resistance in DFUs.
SN  - 2235-2988
ER  -