128
Antibiotic Resistance in EDCs-Induced Metabolic Disorders
Antibiotic Resistance in T2DM
Diabetes mellitus (DM) is a common, debilitating, chronic, and fatal metabolic disease having constantly growing prevalence worldwide. It is of two types, type 1 DM
which is due to autoimmune damage of β-cells of pancreas and T2DM which is
referred as a chronic disease with multifactorial etiology, including abnormal functioning of the anterior hypothalamus and pancreas, both of which can cause insulin
resistance [26, 27]. Along with its clinical complications, T2DM is also associated
with less response of T-cells and neutrophil functions because of altered defensive
mechanisms; hence, T2DM is related to high risk of moderate and severe infection
related morbidity [28]. These infections may include foot infections, gangrenous
cholecystitis, urinary tract infections (UTIs), and soft tissue infections as well as
osteomyelitis, cellulitis, sepsis, and peritonitis [27, 28]. The treatment for all of
these infections is becoming challenging now due to the multidrug resistance
(MDR) exhibited by microorganisms, the most common pathogen among them is
Escherichia coli followed by Proteus species, Klebsiella species, Enterobacter species, Pseudomonas species, and Gram-positive organisms as Staphylococcus
aureus, Enterococcus species, and group B Streptococcus [28]. Diabetes is also
associated with higher risk of infections because of antibiotic-resistant bacteria such
as vancomycin-resistant enterococci, methicillin-resistant S. aureus, broad spectrum β-lactamase-producing Gram-negative bacteria, carbapenam-resistant Gramnegative bacteria, and multidrug-resistant M. tuberculosis [27]. Figure 8.1 represents
the inter-relationship between diabetes, infections, and antibiotic resistance.
Diabetic foot infection (DFI) is a very serious diabetic complication; approximately 25% of all diabetic cases have risks of foot ulcers which can get infected
easily [27]. DFI is relatively treated with broad spectrum antibiotics which ultimately can promote antibiotic resistance and hence resulting in antibiotic-resistant
infections. To prevent such infections, Infectious Diseases Society of America
(IDSA) in 2012 recommended prescribing antibiotics guidelines for clinical practice for the diagnosis and treatment of DFI that (a) prescribe antibiotics with proven
efficacy in the treatment of DFI, (b) offer coverage over common Gram-positive
cocci, and (c) offer less coverage of Gram-negative pathogens [29]. Commonly
prescribed empiric oral antibiotics are co-trimoxazole, clindamycin, amoxicillin–
clavulanate, and levofloxacin, administered for 1–3 weeks in case of soft tissue
infections and 4–6 weeks in case of non-amputated osteomyelitis [29]. To prevent
diabetic infections and associated antibiotic resistance, glycemic level should be
maintained strictly to assist in improving immune functions and hence diminishing
the risks for frequent infections and antibiotic resistance [27].
H. Sharif et al.
Antibiotic Resistance in EDCs-Induced Metabolic Disorders
Antibiotic Resistance in T2DM
Diabetes mellitus (DM) is a common, debilitating, chronic, and fatal metabolic disease having constantly growing prevalence worldwide. It is of two types, type 1 DM
which is due to autoimmune damage of β-cells of pancreas and T2DM which is
referred as a chronic disease with multifactorial etiology, including abnormal functioning of the anterior hypothalamus and pancreas, both of which can cause insulin
resistance [26, 27]. Along with its clinical complications, T2DM is also associated
with less response of T-cells and neutrophil functions because of altered defensive
mechanisms; hence, T2DM is related to high risk of moderate and severe infection
related morbidity [28]. These infections may include foot infections, gangrenous
cholecystitis, urinary tract infections (UTIs), and soft tissue infections as well as
osteomyelitis, cellulitis, sepsis, and peritonitis [27, 28]. The treatment for all of
these infections is becoming challenging now due to the multidrug resistance
(MDR) exhibited by microorganisms, the most common pathogen among them is
Escherichia coli followed by Proteus species, Klebsiella species, Enterobacter species, Pseudomonas species, and Gram-positive organisms as Staphylococcus
aureus, Enterococcus species, and group B Streptococcus [28]. Diabetes is also
associated with higher risk of infections because of antibiotic-resistant bacteria such
as vancomycin-resistant enterococci, methicillin-resistant S. aureus, broad spectrum β-lactamase-producing Gram-negative bacteria, carbapenam-resistant Gramnegative bacteria, and multidrug-resistant M. tuberculosis [27]. Figure 8.1 represents
the inter-relationship between diabetes, infections, and antibiotic resistance.
Diabetic foot infection (DFI) is a very serious diabetic complication; approximately 25% of all diabetic cases have risks of foot ulcers which can get infected
easily [27]. DFI is relatively treated with broad spectrum antibiotics which ultimately can promote antibiotic resistance and hence resulting in antibiotic-resistant
infections. To prevent such infections, Infectious Diseases Society of America
(IDSA) in 2012 recommended prescribing antibiotics guidelines for clinical practice for the diagnosis and treatment of DFI that (a) prescribe antibiotics with proven
efficacy in the treatment of DFI, (b) offer coverage over common Gram-positive
cocci, and (c) offer less coverage of Gram-negative pathogens [29]. Commonly
prescribed empiric oral antibiotics are co-trimoxazole, clindamycin, amoxicillin–
clavulanate, and levofloxacin, administered for 1–3 weeks in case of soft tissue
infections and 4–6 weeks in case of non-amputated osteomyelitis [29]. To prevent
diabetic infections and associated antibiotic resistance, glycemic level should be
maintained strictly to assist in improving immune functions and hence diminishing
the risks for frequent infections and antibiotic resistance [27].
H. Sharif et al.