Diabetes Mellitus and Enhanced Vulnerability to Escherichia coli Catheter-Associated Urinary Tract Infections: Integrative Clinical and Molecular Analysis

Catheter-associated urinary tract infections (CAUTIs) represent a substantial clinical burden, particularly in diabetes Mellitus (DM) patients, with extended duration of catheterization. Escherichia coli remains most prevalent uropathogen, often exhibiting virulence factors, robust biofilm formation, and multidrug resistance (MDR). This study investigates antimicrobial resistance patterns, virulence gene profiles, and biofilm production of E. coli isolates from CAUTI patients with and without diabetes mellitus. A total of 260 CAUTI patients were enrolled in this study, comprising 130 diabetic (HbA1c > 6.5%) and 130 non-diabetic (HbA1c E. coli isolates were analyzed. Antimicrobial susceptibility testing was performed by disk diffusion, Molecular profiling and virulence genes were conducted via polymerase chain reaction (PCR), and biofilm quantification was assessed by microtiter plate method. MDR (89.7%) and XDR (19.2%) phenotypes were significantly more common in diabetic isolates with increased resistance to ß-lactams, fluoroquinolones, carbapenems, and sulfonamides. The most prevalent genes were bla CTX-M, bla NDM and bla OXA-48. Virulence genes (fimH (78%), PapC (50%), FyuA (45%), and KpsMTII (33%) associated with enhanced biofilm formation. Diabetes mellitus (DM) substantially exacerbates CAUTIs caused by E. coli through increased multidrug resistance, virulence genes prevalence and biofilm production emphasizing the need for targeted antimicrobial stewardship and stringent infection control strategies in diabetic populations.