Synergistic Effects of Probiotics and Ciprofloxacin on Gene Expression in Klebsiella Pneumoniae Isolated from Urine and Sputum Specimens

Background: Antibiotic resistance is associated with efflux pumps and resistance genes, among the significant threats to health systems worldwide. The efflux pumps and resistance genes that distinguish many antibiotics are called Multidrug Resistance (MDR), and probiotics are essential treatments for some bacterial inflammation caused by K. pneumonia. Our research, which takes a unique approach by investigating the prevalence of Klebsiella pneumoniae bacteria that cause different clinical infections, has the potential to impact the field of antibiotic resistance studies significantly. By identifying the (AcrA and gyrA) genes using the polymerase chain reaction and exploring the synergistic effect of probiotics and Ciprofloxacin antibiotics on some virulence genes in K. pneumoniae, we aim to contribute to the understanding of antibiotic resistance mechanisms and potential new treatment strategies. Our methods were meticulously designed and executed, underscoring the reliability of our results. From December 2022 to June 2023, we collected 199 samples from patients with urinary tract infections (UTIs) and sputum at Baquba Teaching Hospital and Al-Batoul Maternity Hospital in Diyala Governorate, Iraq. The nucleic acid DNA of the bacterial isolates under study was carefully extracted, and then the polymerase chain reaction (PCR) was performed using specialized gene primers (AcrA and gyrA). The RNA of the bacterial isolates was extracted, and then quantitative real-time (q-Rt PCR) was performed to detect gene expression by the AcrA and gyrA genes. Results: The results of antibiotic sensitivity showed that all isolates were 100% resistant to Ampicillin, 87.71% Cefoxitin, 64.91% Trimethoprim-sulfamethoxazole, 50.87% Amikacin, 35.08% Levofloxacin, 26.31% Imipenem, and 22.80% Ciprofloxacin. The study results showed that all bacterial isolates (22) obtained the genes (AcrA and gyrA) in percentage 100%. The current study showed an inhibition in the gene expression of the AcrA and gyrA genes; there was an inhibition in gene expression for the two isolates (U4, S2) after treatment with probiotics and a synergistic of probiotics and ciprofloxacin and compared to Control. Conclusion: Most Klebsiella pneumoniae isolates under study were isolated from patients with (UTIs) and sputum with multiple antibiotic resistance (MDR). All bacterial isolates possessed the genes (AcrA and gyrA) in a percentage of (100%), and there was inhibition in the gene expression of the AcrA and gyrA genes after treatment with probiotics and a synergistic of probiotics and ciprofloxacin.