SENSITIVITY CHARACTERISTICS OF CONDITIONAL-PATHOGENIC FLORA OF PATIENTS WITH TYPE 2 DIABETES TO ANTIBIOTICS

“INTERNATIONAL CONFERENCE ON INNOVATIVE DEVELOPMENT OF EDUCATION” 2025/1 284 DOI: https://10.5281/zenodo.17944994 SENSITIVITY CHARACTERISTICS OF CONDITIONAL-PATHOGENIC FLORA OF PATIENTS WITH TYPE 2 DIABETES TO ANTIBIOTICS Nurullayeva Sh.M., Xaydarov A.M., Ibragimov Z.Z. Tashkent State Medical University, Tashkent city Emergency Medical Clinical Hospital, Tashkent, Uzbekistan. Objective: Тo study the sensitivity of opportunistic flora to antibiotics in patients with type 2 diabetes mellitus and to recommend antibiotics necessary for the treatment of the disease. Goal: study of bacteriological analysis and antibiotic sensitivity tests in patients with type 2 diabetes mellitus in stage 1 and stage 2 chronic kidney disease (CKD). MATERIALS AND METHODS: Bacteriological and of nasopharyngeal swabs from 45 patients. RESULTS: The following 64 strains of microorganisms were identified when examined by bacteriological methods: E.coli (3/6,8%), Klebsiella spp (13/3,5%), Enterobacter spp (2/7,7%), Citrobacter spp (2/0,67%), Pseudamonas aeruginosa (1/1,1%), Candida spp (19/30,7%), Staphilococcus aureus (5/17,6%), Staphilococcus epidermides (9/4,34%), Staphilococcus haemalyticus (1/3,12%), Streptococcus spp (1/7,8%), Streptococcus viridians (3/7,7%), B-haemalitic streptococcus (1/8,5%). In addition, Proteus spp (1/0.33%) and Streptococcus pyogenes (2/0.33%) were also found among the isolated strains. The largest proportion of isolated microorganisms was fungi (Candida albicans, Candida spp 19/30.65%). The largest proportion of Gram-positive microorganisms was Staphylococcus aureus (5/17.6%). CONCLUSION: Rational use of antibiotics and reduction of anthropogenic factors is necessary. It is necessary to correctly diagnose diseases and recommend groups of antibiotics for effective treatment, taking into account resistance to opportunistic “INTERNATIONAL CONFERENCE ON INNOVATIVE DEVELOPMENT OF EDUCATION” 2025/1 285 infections. Not only patients with type 2 diabetes, but also patients with other types of infectious diseases should only determine antibiotic sensitivity and receive antibiotics that are effective against that microorganism. In particular, the use of cephalosporin and fluoroquinolone antibiotics remains high. Also, due to the emergence of strains resistant to penicillin antibiotics, it is appropriate to recommend them based on the results of antibiotic susceptibility testing. Key words: sensitivity to antibiotics, conditionally pathogenic infections, resistant strains. INTRODUCTION These infections are frequently caused by antibiotic-resistant pathogens. Factors such as immune system impairments, inadequate metabolic control, and incomplete bladder emptying due to autonomic neuropathy may all contribute to the heightened risk of UTIs in this population. Notably, the newer class of anti-diabetic medications known as sodium-glucose cotransporter 2 (SGLT2) inhibitors has not been shown to significantly raise the incidence of symptomatic urinary tract infections. Type 2 diabetes mellitus (T2DM) is a complex metabolic disease characterized by chronic hyperglycemia and impaired carbohydrate metabolism [1]. The pathogenesis of the disease is based on insulin resistance resulting from a deficiency in insulin secretion or a decrease in the sensitivity of peripheral tissues to insulin [1,2]. The main function of the hormone insulin is to exert its effects through the insulin receptor located in the liver, muscle, and adipose tissue. In particular, in liver cells, it increases the conversion of glucose to glycogen and reduces glucose excretion, and in muscle and adipose tissue, it increases glucose uptake via the GLUT4 transport protein. The insulin receptor belongs to the tyrosine kinase superfamily and becomes activated by autophosphorylation upon insulin binding. Therefore, many scientists believe that opportunistic microorganisms are only a small part of human nosocomial and community-acquired infections. [3;4]. Resistance is caused by the indiscriminate use of antibiotics by the population, the misuse of these antibiotics in medicine, their use to promote growth in animals, and a number of other factors. In recent years, “INTERNATIONAL CONFERENCE ON INNOVATIVE DEVELOPMENT OF EDUCATION” 2025/1 286 opportunistic flora has become an urgent problem not only as a nosocomial infection, but also as a community-acquired infection. [5]. MATERIAL AND METHODS All participants were consecutively recruited from the department of Endocrinology at the Tashkent city Emergency Medical Clinical Hospital, Tashkent State Medical University in Tashkent, Uzbekistan. A total of 56 T2DM patients meeting the inclusion criteria were enrolled consecutively from February 2025 to November 2025, with a follow-up of 12 weeks for each participant. All participants were local residents of Tashkent in Uzbekistan. Informed consent was obtained from all participants before their enrollment in the study. T2DM patients Antibiotic susceptibility was studied among 21 men and 35 women. The test material was a swab taken from the nasopharynx using a bacteriological swab. General Information and Blood Samples Examination The patient’s gender, age, height, weight, blood pressure, duration of diabetes, smoking history, alcohol consumption history, and presence of chronic microvascular complications (including diabetic kidney disease (DKD) and diabetic retinopathy (DR), either previously diagnosed or diagnosed during hospitalization were recorded. During this time, swabs were taken from the nasopharynx of patients with diabetes mellitus for bacteriological examination. The samples were cultured on special nutrient media and studied in the Bacteriological Laboratory of the State Medical University of the Republic of Uzbekistan. The isolated bacteria of the conditional pathogenic group were cultured on neutral agar (Muller Hinton Agar) by the lawn method, and sensitivity to antibiotic preparations was determined. And in the environment of Soburo, many fungi can be seen. To determine antibiotic sensitivity, colonies grown on Endo medium were plated on neutral agar using the lawn method. Fluoroquinolones, beta-lactam and tetracycline antibiotics were added. RESULTS When examined by bacteriological methods, the following 897 strains of microorganisms were identified: E.coli (3/6,8%), Klebsiella spp (13/3,5%), “INTERNATIONAL CONFERENCE ON INNOVATIVE DEVELOPMENT OF EDUCATION” 2025/1 287 Enterobacter spp (2/7,7%), Citrobacter spp (2/0,67%), Pseudamonas aeruginosa (1/1,1%), Candida spp (19/30,7%), Staphilococcus aureus (5/17,6%), Staphilococcus epidermides (9/4,34%), Staphilococcus haemalyticus (1/3,12%), Streptococcus spp (1/7,8%), Streptococcus viridians (3/7,7%), B-haemalitic streptococcus (1/8,5%). In addition, Proteus spp (1/0.33%) and Streptococcus pyogenes (2/0.33%) were also found among the isolated strains. The largest proportion of isolated microorganisms was fungi (Candida albicans, Candida spp 19/30.65%). Table 1. Number of strains of microorganisms isolated from patients № Pathohenic microorganisms Number of microbes Patients (45) 1 E.coli 4 3(6,8) 2 Klebsiella spp 13 13(3,5) 3 Enterobacter spp 2 2(7,7) 4 Сitrobacter spp 2 2(0,64) 5 Proteus spp 1 1(0,3) 6 Ps. аeruginosa 1 1(1,1) 7 Staphilococcus aureus 5 5(17,6) 8 Staphilococcus epidermides 9 9(4,35) 9 Staphilococcus haemalyticus 1 1(3,07) 10 Streptococcus spp 1 1(7,82) 11 Streptococcus viridians 3 3(7,7%), 12 B-haemalitic streptococcus 1 1(8,6) 13 Streptococcus piogens 2 2(0,25%) 14 Candida spp 19 19(30,65%). Total: 64 64 The following results were obtained when the level of sensitivity to antibiotics of strains of gram-negative microorganisms was studied: Table 2. Antibiotic susceptibility level of gramnegative strains (M±m,%) № The name of the antibiotic Sensitivity levels Sensitive-S Moderately sensitive-I Resistant-R 1 Amoxicillin + clavulanate 82,7±2.1 15,0±2,0 м 2,4±1,9 2 Ampicillin+sulbactam 1,8±4,3 5,2±1,5 93,0±5,1 3 Cefaperazone/sulbactam 81,1±3,7 10,7±2,5 8,2±3,8 4 Amikacin 2,5±1,7 13,8±4,7 79,1±3,6 5 Doxycycline 59,6±4,1 28,4±3,1 12,0±2,8 6 Tetracycline 60,1±4,7 9,4±0,9 30,5±4,4 7 Ciprofloxacin 58,5±4,1 23,3±3,6 18,2±2,3 8 Levofloxacin 59,6±4,2 28,4±3,1 12,0±2,8 9 Moxifloxacin 58,6±4,1 26,4±3,1 10,0±2,8 10 Ofloxacin 51,6±3,2 21,4±3,1 10,0±2,8 11 Cefpodoxime 48,6±4,7 16,4±3,1 12,0±2,8 12 Cefotaxime 71,4±2.1 11,0±2,1 м 1,8±1,5 13 Ceftriaxone 81,7±2.1 14,0±2,0 м 2,8±1,9 “INTERNATIONAL CONFERENCE ON INNOVATIVE DEVELOPMENT OF EDUCATION” 2025/1 288 Most of these infections showed resistance to doxycycline, amoxicillin, ampicillin+sulbactam. The high prevalence of Gram-positive microorganisms in the nasopharynx, and the pH and temperature there create conditions for these microbes to survive and multiply. Table 3. Antibiotic susceptibility level of grampositive strains (M±m,%) № The name of the antibiotic Sensitivity levels Sensitive-S Moderately sensitive-I Resistant-R 1 Amoxicillin 12,7±2.1 15,0±2,0 м 92,4±1,9 2 Ampicillin+sulbactam 1,8±4,3 5,2±1,5 93,0±5,1 3 Ciprofloxacin 58,5±4,1 23,3±3,6 18,2±2,3 4 Tetracycline 58,1±5,6 38,7±4,7 3,2±1,4 5 Cefaperazone+sulbactam 88,2±5,0 7,2±4,0 4,8±3,3 6 Cefpodoxime (Cefpodo) 55,8±1,4 35,6±5,1 8,6±5,4 7 Ceftriaxone 48,8±2,5 37,6±5,3 13,6±2,4 8 Cefdazidim 5,8±4,6 10,6±4,5 83,6±2,1 9 Azithromycin 1,6±4,3 5,3±1,5 93,1±4,1 10 Amikacin 88,6±4,6 10,7±2,4 2,7±3,9 11 Levofloxacin 80,1±3,6 11,7±2,6 8,2±3,8 12 Cefotaxime 90,5±2,4 7,1±4,5 2,4±3,1 The following results were obtained when the sensitivity characteristics of the isolated gram-positive microorganisms to antibiotics were studied. It was found that most of them are highly sensitive to fluoroquinolone group (ciprofloxacin, levofloxacin) and cefolosporin (ceftriaxone, cefaperazone/sulbactam, ceftazidime) antibiotics. Moderate sensitivity to amikacin and azithromycin drugs and multiresistance to colgan drugs and tetracycline group antibiotics and amoxiclav drug were found. This means that resistant strains of microorganisms are emerging day by day. One of the microorganisms that live permanently in the human body are fungi. When the human immunity decreases, the titer of these microorganisms is immediately observed in this organism. The reason for this is the body's immune system. Because when immunity decreases, their number increases, and these microorganisms also join the inflammatory process as a secondary infection. It is when there is inflammation in the upper and lower respiratory tract that fungi cover this part and often cause pneumonia (fungal pneumonia). Therefore, these microbes play a major role as “INTERNATIONAL CONFERENCE ON INNOVATIVE DEVELOPMENT OF EDUCATION” 2025/1 289 secondary infections. The following table shows the susceptibility of Candida spp. to antifungal drugs. Table 4. Candida spp.нинг замбуруғга қарши препаратларга сезгирлик даражаси(M±m,%) № Antifungals Sensitivity levels Sensitive-S Moderately sensitive-I Resistant-R 1 Fluconazole 98,6±1,7 1,4±3,1 12,0±2,8 2 Intracanazol 18,4±2.1 11,0±2,1 м 71,8±1,5 3 Clotrimazole 11,7±2.1 4,0±2,0 м 61,8±1,9 4 Nystatin 71,4±2.1 11,0±2,1 м 1,8±1,5 5 Nitroxaline 81,7±2.1 14,0±2,0 м 2,8±1,9 This table shows that fluconazole and nitroxaline were found to be the most sensitive antifungal drugs. Nystatin was found to be moderately sensitive, and intraconazole and clotrimazole were found to be the least sensitive. CONCLUSION From the obtained results, it is known that the antibiotic resistance of isolated opportunistic infections is increasing day by day. 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