Abstract
The Hospital Infantil de México Federico Gómez (HIMFG) is a tertiary care hospital in Mexico City where Escherichia coli is frequently isolated from the urine samples of pediatric patients with urinary tract infections. A collection of 178 urinary Escherichia coli (UEc) isolates associated with complicated and uncomplicated urinary tract infections were evaluated in this study. The patterns of resistance to 9 antibiotic classes showed that 60.7% of the UEc isolates had a highly multidrug-resistant (MDR) profile. Genetic diversity analyses of the UEc isolates showed a high variability and revealed 16 clusters associated with four phylogenetic groups, namely, groups A, B1, B2, and D. Phylogenetic group B2 was widely associated with the 16 clusters as well as with virulence and fitness genes. The virulence and fitness genes in the UEc isolates, which included fimbriae-, siderophore-, toxin-, and mobility-associated genes, were grouped as occurring at a low, variable, or high frequency. Interestingly, only the papF gene could be amplified from some UEc isolates, and the sequence analysis of the pap operon identified an insertion sequence (IS) element and gene loss. These data suggested pathoadaptability and the development of immune system evasion, which was confirmed by the loss of P fimbriae-associated agglutination in the UEc isolates. E. coli clone O25-ST131 had a prevalence of 20.2% among the UEc isolates; these isolates displayed both a highly MDR profile and the presence of the papGII, fimH, papGIII, iutD, sat, hlyA, and motA genes. In conclusion, the UEc isolates from complicated urinary tract infection (cUTI) were characterized as being MDR, highly genetically diverse, and associated with phylogenetic group B2 and many virulence and fitness genes. Additionally, gene loss and IS elements were identified in some UEc isolates identified as clone O25-ST131.
Highlights
Urinary tract infections (UTIs) are the second leading cause of bacterial infections, and they affect approximately 150 million people worldwide per year
We reported that fusion proteins are highly stable, have antigenic properties, and induce cytokine release and Urinary Escherichia coli isolated from children with urinary tract infections that antibodies against these proteins promote protection during bacterial infection [15]
67.4% (120/178) of the isolates were collected from patients in the nephrology (NP), urology (UR), pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), oncology (ONC), hematology (HEM), general pediatric surgery (GPS), transplant unit (TRU), tissue engineering (TE), internal therapy (IT), surgical therapy (ST), infectology (INF), internal medicine (IM), and emergency (EW) wards; these isolates were considered complicated urinary tract infection (cUTI) (S2 Table)
Summary
Urinary tract infections (UTIs) are the second leading cause of bacterial infections, and they affect approximately 150 million people worldwide per year. UTIs are clinically classified as either uncomplicated or complicated. Uncomplicated UTIs (uUTIs) affect healthy individuals without structural or neurological abnormalities in the urinary tract; uUTIs are commonly known as cystitis (lower urinary tract) or pyelonephritis (upper urinary tract) and are mainly acquired in the community [2]. Complicated UTIs (cUTIs) have been associated with factors related to urinary tract dysfunction (urinary obstruction, urinary retention, and renal failure), host defense (immunosuppression, renal transplantation and pregnancy), and foreign bodies (calculi and catheters or other drainage devices) [3,4,5,6]. Catheter-associated UTI is considered the most important nosocomially acquired infection, raising the economic cost, increasing the number of hospital days per patient, and promoting the development of antibiotic resistance, thereby complicating treatment [7]
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