Escherichia coli Isolated from Diabetic Foot Osteomyelitis: Clonal Diversity, Resistance Profile, Virulence Potential, and Genome Adaptation.

Alexi Lienard,Joanne Jneid,Bernard La Scola,Jean-Philippe Lavigne,Michel Hosny,Albert Sotto,Nicolas Cellier,Sophie Schuldiner,Alix Pantel

doi:10.3390/microorganisms9020380

Abstract

This study assessed the clonal diversity, the resistance profile and the virulence potential of Escherichia coli strains isolated from diabetic foot infection (DFI) and diabetic foot osteomyelitis (DFOM). A retrospective single-centre study was conducted on patients diagnosed with E. coli isolated from deep DFI and DFOM at Clinique du Pied Diabétique Gard-Occitanie (France) over a two-year period. Phylogenetic backgrounds, virulence factors (VFs) and antibiotic resistance profiles were determined. Whole-genome analysis of E. coli strains isolated from same patients at different periods were performed. From the two-years study period, 35 E. coli strains isolated from 33 patients were analysed; 73% were isolated from DFOM. The majority of the strains belonged to the virulent B2 and D phylogenetic groups (82%). These isolates exhibited a significant higher average of VFs number than strains belonging to other groups (p < 0.001). papG2 gene was significantly more detected in strains belonging to B2 phylogroup isolated from DFI compared to DFOM (p = 0.003). The most prevalent antibiotic resistance pattern was observed for ampicillin (82%), cotrimoxazole (45%), and ciprofloxacin (33%). The genome analysis of strains isolated at two periods in DFOM showed a decrease of the genome size, and this decrease was more important for the strain isolated at nine months (vs. four months). A shared mutation on the putative acyl-CoA dehydrogenase-encoding gene aidB was observed on both strains. E. coli isolates from DFOM were highly genetically diverse with different pathogenicity traits. Their adaptation in the bone structure could require genome reduction and some important modifications in the balance virulence/resistance of the bacteria.

Highlights

Introduction conditions of the Creative CommonsDiabetic foot ulcers (DFUs) are estimated to affect 19 to 34% of all diabetic individuals during their lifetime [1]
We described E. coli strains isolated from diabetic foot osteomyelitis (DFOM)/deep diabetic foot infection (DFI), determined their phylogenetic relationships, virulence profiles, antibiotic resistance, and genome adaptation for two persistent infections
This study characterised the E. coli strains isolated from DFOM and deep DFI and demonstrated that these bacteria were highly genetically diverse with different pathogenicity traits

Summary

Introduction

Diabetic foot ulcers (DFUs) are estimated to affect 19 to 34% of all diabetic individuals during their lifetime [1]. Infection of these ulcers is frequent (40–80%), representing a major cause of mortality and morbidity [2]. Microorganisms 2021, 9, 380 a common complication of DFU and/or diabetic foot infections (DFI) [3]. In Western developed countries, DFI are mainly caused by aerobic Gram-positive cocci In deep ulcers or wounds occurring in a patient who has been previously treated by antibiotics, DFI/DFOM are more often polymicrobial, including aerobic Gram-negative and obligate anaerobic bacteria. Recent epidemiological studies from subtropical countries described a considerably higher predominance of

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Conclusion