Abstract
Of the most common infectious diseases that occur mainly by uropathogenic Escherichia coli (UPEC) is urinary tract infections (UTIs). The purpose of this study was to investigate virulence factors, antibiotic resistance, and phylogenetic groups among UPEC strains isolated from patients with UTI in southern Iraq. A total of 100 UPEC isolates were collected from urine samples of UTI patients from various hospitals in southern Iraq, and confirmed by morphological and biochemical tests. Antimicrobial susceptibility testing on isolates was performed by disk diffusion method. Multiplex PCR techniques were used to evaluate the phylogenetic groups based on Clermont method and to detect the presence of six virulence factor genes. The majority of isolates belonged to the phylogenetic groups B2 (46%) and C (13%). The most prevalent virulence factors were fimH (96%), followed by aer (47%), papC (36%), cnf1 (17%), hly (15%), and afa (8%). Phenotypic testing showed that the isolates were most resistant to piperacillin, ticarcillin, amoxicillin/clavulanic acid (92%, 91%, and 88%, respectively) and most sensitive to amikacin and imipenem, respectively. The maximum antibiotic resistance and virulence factors were observed in the phylogenetic group B2. The results showed that the UPEC isolates had all six virulence factors with high frequency and the highest drug resistance. Besides, the results showed a direct relationship between virulence factors, gene diversity, phylogenetic background, and antimicrobial resistance in the UPEC isolates.
Highlights
Urinary Tract Infections (UTIs), after respiratory infections, are one of the most common infections among hospitalized patients and referrals to laboratories (Demirci et al, 2019).Escherichia coli accounts for over 80–90% of community-acquired urinary tract infections (UTIs) and 30–50% of hospital-acquired UTIs and is one of the major contributors to hospitalization with severe complications and high healthcare costs
The present results showed that 96% of the isolates had at least one variant of the genes encoding virulence factors, and the distribution of virulence genes were as follows: fimH (96%), aer (47%), papC (36%), cnf1 (16%), hly (15%), and afa (8%), respectively. fimH, due to its high percentage among uropathogenic Escherichia coli (UPEC) strains and its role in bacterial binding to urinary tract cells and colonization, is considered as a potential candidate to develop vaccine preventing urinary tract infections (Dadi et al, 2020)
The polymerase chain reaction technique was used to classify the uropathogenic Escherichia coli isolates into phylogenetic groups
Summary
Urinary Tract Infections (UTIs), after respiratory infections, are one of the most common infections among hospitalized patients and referrals to laboratories (Demirci et al, 2019).Escherichia coli accounts for over 80–90% of community-acquired UTIs and 30–50% of hospital-acquired UTIs and is one of the major contributors to hospitalization with severe complications and high healthcare costs. The ExPEC strains, compared with commensal E. coli strains, have bigger genomes and express more virulence factors (Rasko et al, 2008). Vital virulence factors in the UPEC developing resistance to the host defense system and contributing to adhesion, invasion, and damage to the host cell include adhesins, toxins, siderophores, polysaccharide-based protective coatings, inosines, and serum resistance-related proteins (Johnson et al, 2005). The genes expressing virulence factors are located on bacterial chromosomes, plasmids, and even bacteriophages and can be transferred horizontally or vertically between bacteria (Piatti et al, 2008). Cytotoxic necrosis factor 1 (cnf1) is produced by 40% of UPECs, which is involved in bacterial spread and survival in urinary tracts. The activity of the cytolytic factor of α-hemolysin encoded by hlyA gene contributes to bacterial invasion into the epithelial barrier (Trifillis et al, 1994)
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