Abstract
BackgroundUrinary tract infections (UTIs) are one of the most frequent diseases encountered by humans worldwide. The presence of multidrug-resistant (MDR) uropathogenic Escherichia coli (UPEC) harboring several virulence factors, is a major risk factor for inpatients. We sought to investigate the rate of antibiotic resistance and virulence-associated genes among the UPECs isolated from an Iranian symptomatic population.MethodsA total of 126 isolates from inpatients with UTI from different wards were identified as UPEC using the conventional microbiological tests. After identification of UPECs, all the isolates were subjected to antimicrobial susceptibility test and polymerase chain reaction (PCR) to identify the presence of 9 putative virulence genes and their association with the clinical outcomes or antimicrobial resistance.ResultsThe data showed that the highest and the lowest resistance rates were observed against ampicillin (88.9%), and imipenem (0.8%), respectively. However, the frequency of resistance to ciprofloxacin was found to be 55.6%. High prevalence of MDR (77.8%) and extended-spectrum β-lactamase (ESBL) (54.8%) were substantial. PCR results revealed the frequency of virulence genes ranged from 0 to 99.2%. Among 9 evaluated genes, the frequency of 4 genes (fimH, sfa, iutA, and PAI marker) was > 50% among all the screened isolates. The iutA, pap GII, and hlyA genes were more detected in the urosepsis isolates with significantly different frequencies. The different combinations of virulence genes were characterized as urovirulence patterns. The isolates recovered from pyelonephritis, cystitis, and urosepsis cases revealed 27, 22, and 6 virulence patterns, respectively. A significant difference was determined between ESBL production with pap GII, iutA, and PAI marker genes.ConclusionsOur study highlighted the MDR UPEC with high heterogeneity of urovirulence genes. Considering the high rate of ciprofloxacin resistance, alternative drugs and monitoring of the susceptibility profile for UPECs are recommended.
Highlights
Urinary tract infections (UTIs) are one of the most frequent diseases encountered by humans worldwide
It is suggested that uropathogenic Escherichia coli (UPEC) isolates usually harbor the largest number of pathogenicity-associated islands (PAIs) encoding a variety of virulence determinants involved in adhesion, invasion, and bacterial resistance to host defense and influencing the pathogenicity of symptomatic or complicated UTIs [6, 7]
There have been limited published epidemiologic studies on virulence genes and antimicrobial resistance among the UPECs isolated from symptomatic patients with UTI in Iran, the present study aimed to evaluate the important characteristics of UPEC isolates, as well as investigate the correlation between the urovirulence genes and the type of clinical disease or antibiotic resistance from Shiraz, Iran
Summary
Urinary tract infections (UTIs) are one of the most frequent diseases encountered by humans worldwide. Urinary tract infections (UTIs) are the most frequent human infections occurring to people of all ages, which cause morbidity and significant mortality globally [1, 2]. UPEC strains usually carry a series of virulence markers, including adhesins, toxins and iron uptake systems (siderophores) that enable them to invade, colonize, and survive in the urinary tract, and prevent them from removal during urination [1, 4, 5]. It is suggested that UPEC isolates usually harbor the largest number of pathogenicity-associated islands (PAIs) encoding a variety of virulence determinants involved in adhesion, invasion, and bacterial resistance to host defense and influencing the pathogenicity of symptomatic or complicated UTIs [6, 7]. In an ascending manner would be able to move to the kidney, causing an acute pyelonephritis or disseminates to the blood leading to urosepsis [4, 6]
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