Molecular Phylogenetic and Risk Factors of Klebsiella aerogenes in Diabetic Foot Ulcers: A First Study from Iraq

Abstract

Aims: Molecular phylogenetic profiling of Klebsiella aerogenes in diabetic foot ulcers and estimating the relationship of infection to some related risk factors. Study Design: The current study designed to indicate the implication of K. aerogenes in foot ulcers of diabetic patients. Place and Duration of Study: Swab samples were collected from foot ulcer of an overall 143 diabetic patients at Al-Qadisiyah province (Iraq) between February 2025 and April 2025. Methodology: Swab samples of all study individuals were examined molecularly by conventional PCR assay, and some of positive study isolates were sequenced. The received sequence 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. Results: Totally, 13.29% of foot ulcers were positive to K. aerogenes infection. Sequencing data and pahylogenetic analysis of 10 study K. aerogenes isolates with the global GenBank-BLAST K. aerogenes isolates / strains revealed an identity and substitution / mutation at range of 99.25-99.86% and 0.0001-0.0014%, respectively with 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. Conclusion: This represents the first Iraqi study demonstrates the presence of K. aerogenes in diabetic foot ulcers indicating the need for moreover studies.