Bacterial Morphotypes as Important Trait for Uropathogenic E. coli Diagnostic; a Virulence-Phenotype-Phylogeny Study

Manuel G Ballesteros-Monrreal,Edwin Barrios-Villa,Rafael De La Rosa-López,Enrique Bolado-Martínez,Pablo Taboada,Margarita M P Arenas-Hernández,Dora Valencia,Maritza Lizeth Álvarez-Ainza,Josue Juarez

doi:10.3390/microorganisms9112381

Abstract

Urinary tract infections (UTIs) belong to the most common pathologies in Mexico and are mainly caused by Uropathogenic Escherichia coli (UPEC). UPEC possesses a wide diversity of virulence factors that allow it to carry out its pathogenesis mechanism in the urinary tract (UT). The development of morphotypes in UT represents an important feature of UPEC because it is associated with complications in diagnosis of UTI. The aim of this study was to determine the presence of bacterial morphotypes, virulence genes, virulence phenotypes, antibiotic resistant, and phylogenetic groups in clinical isolates of UPEC obtained from women in Sonora, Mexico. Forty UPEC isolates were obtained, and urine morphotypes were observed in 65% of the urine samples from where E. coli was isolated. Phylogenetic group B2 was the most prevalent. The most frequent virulence genes were fimH (100%), fliCD (90%), and sfaD/focC (72%). Biofilm formation (100%) and motility (98%) were the most prevalent phenotypes. Clinical isolates showed high resistance to aminoglycosides and β-lactams antibiotics. These data suggest that the search for morphotypes in urine sediment must be incorporated in the urinalysis procedure and also that clinical isolates of UPEC in this study can cause upper, lower, and recurrent UTI.

Highlights

Urinary tract infections (UTIs) are one of the most common pathologies in Mexico with more than 4 million cases reported each year [1,2]
UTIs are common in both males and females, the prevalence is higher in women (>70%)
We observed that bacterial morphotypes were more frequent in urine sediments from patients with recurrent UTI episodes than patients without it. This is in accordance with the reported by Robino, Rosen, and Martinez-Figueroa [11,17,40]. These results suggest that the method used in the clinical diagnosis of UTI needs to be modified, the search for these uropathogenic Escherichia coli (UPEC) morphotypes in urinary sediment must be done routinely to avoid misdiagnosis, and Sternheimer-Malbin dye could be implemented for detection of these bacterial morphotypes

Summary

Introduction

Urinary tract infections (UTIs) are one of the most common pathologies in Mexico with more than 4 million cases reported each year [1,2]. UTIs are common in both males and females, the prevalence is higher in women (>70%). In this regard, it is estimated that 50% of all women worldwide will present at least one episode of UTI in their lives, and 30% of this population will experience recurrent episodes [3,4]. In contrast to other E. coli pathotypes, UPEC does not possess a specific virulence profile, but its virulence genes are mainly associated with characteristics such as adherence, motility, iron capture, and toxigenicity. These virulence features allow UPEC to adapt and carry out successfully its pathogenesis

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