Pilot Phenotypic Mapping to Ambler Classes in Diabetic Urosepsis: Outcomes and Stewardship Insights
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Abstract
Background: Urosepsis occurs in uncontrolled diabetes mellitus (DM) with a high morbidity because of changing beta-lactam resistance, which may become a problem in the empiric treatment and clinical outcomes. Aim and Objective: The aim and objective of this study were to answer the research question: “How do phenotypic antibiotic resistance patterns in urosepsis among patients with uncontrolled diabetes mellitus map to the Ambler Classification of β-lactamases, and what are their associations with clinical outcomes such as acute kidney injury (AKI) and length of stay (LOS)?” Methods: A retrospective pilot cohort study was conducted at Karuna Medical College and Hospital that analyzed 17 urosepsis patients with uncontrolled DM. Available, clinical (HbA1c, serum creatinine/AKI, LOS, interventions, haemodialysis, mortality) and microbiological data were extracted. Descriptive and inferential tests were conducted. The phenotypic patterns were deduced on Ambler proxies, and polymerase chain reaction (PCR) was suggested to confirm them. Ten studies (2014-2025) were included in a systematic review and of them three in meta-analysis based on PubMed, Scopus, and Embase, random-effects modelling of Extended spectrum betalactamase (ESBL) prevalence. Results: AKI prevalence was 88.24%, mean LOS = 8.18 (SD 6.03), interventions = 11.76, and mortality was 0. The most common by prevalence was E. coli (47.06%); phenotypic inference suggested probably Class A in 52.94%. No significant associations were identified (all p>0.05). ESBL prevalence was 26.5% (95% CI -33.7 86.7) with high heterogeneity (I2=98.2%, p=0.001). Conclusion: Phenotypic patterns provide useful proxies of Ambler mapping to inform directed therapy, bypassing empiric shortcomings. PCR and AI combined studies should be carried out on a larger scale.
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Copyright (c) 2026 Kiran D.R., S Veerakesari, Sarathlal S, Aleena Thomas Cheeran, Hariharan A, Pushpadasan P.R, Swathi N, Deena PM, Krishnendhu AM, Meenakshi C
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