Abstract
Uropathogenic Escherichia coli is the common pathogen to cause urinary tract infections (UTIs) and have become multidrug-resistant (MDR) extended-spectrum β-lactamase (ESBL) producers. The differences in the antimicrobial susceptibility, 5 bla genes, 12 virulence genes of 87 clinical ESBL-producing E. coli isolates and genomic variations and sequence types of 18 recurrent and repeated isolates from 9 patients were investigated. The 87 MDR-ESBL isolates collected mainly from indwelling urinary catheters (IUCs) and UTIs were highly resistant to fluoroquinolones, with over 50% of the isolates being resistant to cefepime and piperacillin/tazobactam and a few being resistant to carbapenem. These isolates carried at least two of the five bla genes examined, with the highest prevalence (87.4%) found for blaCTX-M (blaCTX-M3-like and blaCTX-M14-like), followed by blaCMY-2 (80.5%) and blaSHV (56.3%). The predominant virulence genes were the fimbriae gene fimH and the toxin genes cnf1 and hlyA in blood isolates and the capsule gene kpsMTII in UTI and blood isolates. Over 80% of the isolates carried yersiniabactin and aerobactin of siderophores. In 18 isolates, the fluoroquinolone-resistant ST131 isolate of pulsotypes I and II with blaCTX-M-15 was clonally disseminated in the hospital. The genomic plasticity of these ST131 occurred mainly through the conjugative plasmids with differences in replicon types A/C, I1, FIA, FIB and Y, size and number. In conclusion, MDR ESBL-producing E. coli isolates differed in virulence genes of UPEC and antibiotic resistance associated with the sources. Plasmid acquisition and chromosomal variations increase the spread of fluoroquinolone-resistant UPEC ST131 worldwide.
Highlights
Diverse Escherichia coli is an opportunistic pathogen that causes gastroenteritis, bacteremia, bladder infections, meningitis or pus [1]-[3]
Related strains with multidrug resistance are the characteristics of urinary tract infections (UTIs)- and catheter-associated UTIs (CAUTIs)-associated E. coli, which carry similar virulence genes as uropathogenic E. coli (UPEC) [7] and account for more than 40% of all nosocomial infections in hospitals and nursing homes [3] [7]-[9]
The replicons of the conjugation plasmid were examined as above [20]. These Extended-Spectrum Beta-Lactamase (ESBL)-producing E. coli isolates were predominantly collected from indwelling urinary catheters (IUCs) (43%) and urine (26%), followed by blood and sputum, wounds (Table 2)
Summary
Diverse Escherichia coli is an opportunistic pathogen that causes gastroenteritis, bacteremia, bladder infections, meningitis or pus [1]-[3]. Related strains with multidrug resistance are the characteristics of UTI- and catheter-associated UTIs (CAUTIs)-associated E. coli, which carry similar virulence genes as UPEC [7] and account for more than 40% of all nosocomial infections in hospitals and nursing homes [3] [7]-[9]. Important factors that lead to ESBL-producing E. coli-associated nosocomial infection are the use of extended-spectrum cephalosporins and urethral catheterization [10]-[12]. The most prevalent uropathogenic E. coli ST131 strains differ in their uropathogenic virulence factors, are associated with phylogroup B2, and carry IncF, IncN, IncA/C, and IncI1 plasmids, with a size ranging from 50 to >200 kb [13]-[16]. The aims of this study were to characterize the ESBL-producing E. coli with differences in uropathogenic virulence genes and to investigate the genomic and plasmid variations of E. coli ST131 based on nine episodes of recurrent infections and repeated isolation
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