Antibiotic Susceptibility and Molecular Characterization of Uropathogenic Escherichia coli Associated with Community-Acquired Urinary Tract Infections in Urban and Rural Settings in South Africa.

Purity Z Kubone,Usha Govinden,Akebe Luther King Abia,Sabiha Y Essack,Koleka P Mlisana

doi:10.3390/tropicalmed5040176

Purity Z Kubone, Usha Govinden + Show 3 more

Open Access

https://doi.org/10.3390/tropicalmed5040176

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Abstract

We investigated the phenotypic and genotypic antibiotic resistance, and clonality of uropathogenic Escherichia coli (UPEC) implicated in community-acquired urinary tract infections (CA-UTIs) in KwaZulu-Natal, South Africa. Mid-stream urine samples (n = 143) were cultured on selective media. Isolates were identified using the API 20E kit and their susceptibility to 17 antibiotics tested using the disk diffusion method. Extended-spectrum β-lactamases (ESBLs) were detected using ROSCO kits. Polymerase chain reaction (PCR) was used to detect uropathogenic E. coli (targeting the papC gene), and β-lactam (blaTEM/blaSHV-like and blaCTX-M) and fluoroquinolone (qnrA, qnrB, qnrS, gyrA, parC, aac(6’)-Ib-cr, and qepA) resistance genes. Clonality was ascertained using ERIC-PCR. The prevalence of UTIs of Gram-negative etiology among adults 18–60 years of age in the uMgungundlovu District was 19.6%. Twenty-six E. coli isolates were obtained from 28 positive UTI samples. All E. coli isolates were papC-positive. The highest resistance was to ampicillin (76.9%) and the lowest (7.7%) to amoxicillin/clavulanic acid and gentamycin. Four isolates were multidrug-resistant and three were ESBL-positive, all being CTX-M-positive but SHV-negative. The aac(6’)-Ib-cr and gyrA were the most detected fluoroquinolone resistance genes (75%). Isolates were clonally distinct, suggesting the spread of genetically diverse UPEC clones within the three communities. This study highlights the spread of genetically diverse antibiotic-resistant CA-UTI aetiologic agents, including multidrug-resistant ones, and suggests a revision of current treatment options for CA-UTIs in rural and urban settings.

Highlights

Urinary tract infections (UTIs) are among the most common bacterial infections globally
The prevalence of community-acquired urinary tract infections (CA-UTIs) of Gram-negative etiology among adults 18–60 years of age in the uMgungundlovu District was 19.6%, with uropathogenic Escherichia coli (UPEC) accounting for 81.3% of all the pathogens isolated
Isolates displayed extensive clonal diveresity based on the Enterobacterial Repetitive Intergenic Consensus (ERIC)-Polymerase chain reaction (PCR) analyses

Summary

Introduction

Urinary tract infections (UTIs) are among the most common bacterial infections globally. By 2016, it was estimated that 150 million cases occurred annually worldwide [1]. These infections are a substantial cause of morbidity in both males and females with the latter being more frequently infected [1]. CA-UTIs are defined as those UTIs occurring within a community or within 48 hours of hospitalization and not incubating at the time of hospitalization [3]. These infections are the second frequently diagnosed infections in communities [4]

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