Association between Escherichia coli adhesion markers and mannose-binding lectin gene polymorphisms in Type 2 diabetic patients with urinary tract infections

Background: Recurrent urinary tract infections (UTIs) associated with Escherichia coli (E. coli) clinical burden in type 2 diabetic patients (T2DM), increase morbidity and antimicrobial resistance. This study investigated the prevalence of E. coli adhesion genes, and their association with mannose-binding lectin 2 (MBL2) gene polymorphisms in diabetic patients. Methods: A comparative cross-sectional study of (236) T2DM patients with recurrent UTIs, as well as (64) diabetic controls without recurrence. Isolates were identified by conventional microbiological methods. Antimicrobial susceptibility, extended-spectrum beta-lactamase (ESBL) production, and multidrug resistance (MDR) profiles were determined. Polymerase chain reaction (PCR) and Restriction fragment length polymorphism (RFLP) were done for E. coli adhesin genes (papGII, papGIII) and MBL2 codon 54 polymorphisms (rs1800450). Results: E. coli was the predominant pathogen (81.8%), papGII was significantly more prevalent in cases than controls (50.4% vs p < 0.001). No significant association was observed between MBL2 genotypes and UTI risk. ESBL and MDR strains were more frequent in controls (37.5% and 39.1%, respectively) compared with cases, whereas antibiotic susceptibility was higher among cases (41.1% vs. 23.4%). Conclusion: E.Coli adhesion genes, particularly papGII, are strongly associated with recurrent UTIs in T2DM, while MBL2 polymorphisms showed no significant role. These findings highlight the importance of bacterial virulence markers in diabetic UTIs rather than host genetic variation as the main determinant of infection risk in this population.