Investigation of the Presence of A/C, P, and T Replicon Plasmids Among Uropathogenic Escherichia coli Isolates From Baghdad, Iraq, and Their Associations With Antimicrobial Resistance

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Background: Antimicrobial resistance (AMR) is one of the modern world’s most pressing challenges. Conjugation is a crucial method of AMR dissemination in bacteria caused by broad host range plasmids. Objectives: In the present study, we investigated the presence of IncA/C, IncP, and IncT replicon plasmids in uropathogenic Escherichia coli (UPEC) isolates and their associations with AMR. Materials and Methods: From March 2023 to September 2023, 150 UPEC isolates were collected from various public hospitals in Baghdad, Iraq. The AMR profiles of the isolates were investigated using the Kirby-Bauer disc diffusion method. The presence of IncA/C, IncP, and IncT replicon plasmids was evaluated using the multiplex PCR method. The phylogenetic group of the positive UPEC isolates was determined using Clermont E. coli phylo-typing. Results: A multidrug resistance (MDR) profile was found in 98% of UPEC isolates. The highest resistance rates were against tetracycline (89.3%), nalidixic acid (85.3%), and trimethoprim-sulfamethoxazole (85.3%). IncP, IncA/C, and IncT replicon plasmids were found in 4.7, 4.7, and 0% of UPEC isolates, respectively. The IncA/C-positive UPEC isolates belonged to the phylogroups B2 (5 isolates), A (1 isolate), and F (1 isolate). In comparison, the IncP-positive isolates belonged to the phylogroups E (3 isolates), A (2 isolates), and B2 (2 isolates). The statistical analysis showed associations between IncA/C and resistance to imipenem and between IncP and resistance to nalidixic acid and cefotaxime (P<0.05). Conclusion: The findings indicate the spread of AMR in UPEC isolates. IncA/C and IncP broad host range plasmids can be a warning sign for spreading AMR among different bacteria. Additionally, the presence of these plasmids in pathogenic isolates (phylogroup B2) can lead to the formation of strains with high pathogenicity and broad AMR. Therefore, continuous monitoring of these plasmids in UPEC isolates is of crucial importance.