Molecular Detection and Phylogenetic Analysis of <i>Klebsiella aerogenes</i> in Diabetic Foot Ulcers in Iraq

Klebsiella aerogenes is a nosocomial bacterium which recognized increasingly as a significant contributor to the complexity and recalcitrance of diabetic foot ulcers. The study looks at molecular phylogenetic profiling of K. aerogenes in diabetic foot ulcers and estimating the relationship of infection to some related risk factors. Swab samples were collected from foot ulcer of an overall 143 diabetic patients at Al-Qadisiyah province, and subjected to molecular examination using the conventional PCR assay. Then, some positive K. aerogenes isolates were sent for sequencing, and the received data were submitted to the NCBI-GenBank database, and then analysed phylogenetically using the MEGA-11 software. Information related to age and sex of study patients as well as type of diabetes and glycemic control had been recorded as risk factors. Totally, there were 13.29% positive foot ulcers to K. aerogenes infection. Sequencing data and pahylogenetic analysis of 10 study K. aerogenes isolates revealed the presence of similarity (*) at range of 99.25-99.86% and substitution / mutation at range of 0.0001-0.0014% with the global GenBank-BLAST K. aerogenes isolates / strains; in particular Polish K. aerogenes strain (ID: OM250432.1). For risk factors, positive K. aerogenes infection was observed significantly in patients aged 30-50 (11.86%) and >50 (14.63%) years more than <30 (0%) years; males (14.66%) more than females (7.41%); type 2 diabetes (14.17%) more than type 1 (6.25%); and glycemic uncontrolled (17.07%) more than glycemic controlled (8.2%) patients. Subsequently, the risk of K. aerogenes infection was elevated significantly in patients aged >50 years more than 30-50 years and <30 years; males more than females; type 2 diabetes more than type 1; and glycemic uncontrolled more than controlled patients. This might represent the first Iraqi molecular phylogenetic study implicates K. aerogenes in diabetic foot ulcers indicating the need for moreover studies. Also, the nuanced interplay between bacterial virulence factors, host immune responses and the development of antimicrobial resistance necessitates a re-evaluation of current diagnostic and therapeutic paradigms for diabetic foot ulcers.