Incidence of multidrug resistance, pathogenicity island markers, and pathoadaptive FimH mutations in uropathogenic Escherichia coli isolated from asymptomatic hospitalized patients.

Abstract

Asymptomatic uropathogenic Escherichia coli (UPECs) are the leading cause of asymptomatic bacteriuria (ABU) in humans. So this study aimed to identify and characterize ABU UPECs from hospitalized patients of Kolkata, India, with respect to their antibiogram profile, phylogeny, pathogenicity islands, and virulence factor gene acquisition and FimH mutations in comparison to symptomatic UPECs. E. coli was detected biochemically in 44.44% (20/45) and 32.26% (20/62) of urine culture-positive asymptomatic and symptomatic hospitalized individuals respectively. Ninety-five percent of the asymptomatic isolates were multidrug resistant (MDR) compared to the symptomatic isolates (100%). Significant predominance of unknown phylogroup, pathogenicity island markers (PAI IV536, PAI I CFT073), and distribution patterns of different virulence factor genes respectively was evident among both groups. A significant correlation was observed between both groups of isolates with respect to their antibiotic resistances (except imipenem, amikacin, and nitrofurantoin), prevalence of phylogenetic groups and PAIs, and virulence factor gene (fimH, papC, papEF, papGII, iucD, and cnf1) acquisition. Pathoadaptive FimH adhesin mutations, especially hot spot mutation V27A, were detected in 80% asymptomatic isolates mostly reported in symptomatic ones worldwide. Moreover, this is the first study from India that reported incidence of "Unknown" phylogroup, pathogenicity island markers, and potentially pathoadaptive FimH mutations in asymptomatic UPECs isolated from hospitalized patients which further indicated that these ABU E. coli might have originated from their symptomatic counterparts due to unbridled use of unprescribed antibiotics. Therefore, this study demands antibiotic de-escalation along with regular and intricate monitoring at the molecular level for efficient management of ABU that addresses a major public health concern.