Abstract
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 < 5.7%) individuals admitted to various wards of DHQ Hospital, Jhang, between January 2023 and January 2024. From 183 urine culture-positive urine samples 123 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.