Molecular Epidemiology of Multidrug-Resistant Uropathogenic Escherichia coli O25b Strains Associated with Complicated Urinary Tract Infection in Children.

Juan Pablo Reyes-Grajeda,Ariadnna Cruz-Córdova,Virginia Alcázar-López,José Arellano-Galindo,Rigoberto Hernández-Castro,Graciela Castro-Escarpulli,Juan Xicohtencatl-Cortes,Gerardo Escalona-Venegas,Sergio Zavala-Vega,Víctor Flores,Laura M. Contreras-Alvarado,Sara A. Ochoa

doi:10.3390/microorganisms9112299

Abstract

Background: Uropathogenic Escherichia coli (UPEC) has increased the incidence of urinary tract infection (UTI). It is the cause of more than 80% of community-acquired cystitis cases and more than 70% of uncomplicated acute pyelonephritis cases. Aim: The present study describes the molecular epidemiology of UPEC O25b clinical strains based on their resistance profiles, virulence genes, and genetic diversity. Methods: Resistance profiles were identified using the Kirby–Bauer method, including the phenotypic production of extended-spectrum β-lactamases (ESBLs) and metallo-β-lactamases (MBLs). The UPEC serogroups, phylogenetic groups, virulence genes, and integrons were determined via multiplex PCR. Genetic diversity was established using pulsed-field gel electrophoresis (PFGE), and sequence type (ST) was determined via multilocus sequence typing (MLST). Results: UPEC strains (n = 126) from hospitalized children with complicated UTIs (cUTIs) were identified as O25b, of which 41.27% were multidrug resistant (MDR) and 15.87% were extensively drug resistant (XDR). The O25b strains harbored the fimH (95.23%), csgA (91.26%), papGII (80.95%), chuA (95.23%), iutD (88.09%), satA (84.92%), and intl1 (47.61%) genes. Moreover, 64.28% were producers of ESBLs and had high genetic diversity. ST131 (63.63%) was associated primarily with phylogenetic group B2, and ST69 (100%) was associated primarily with phylogenetic group D. Conclusion: UPEC O25b/ST131 harbors a wide genetic diversity of virulence and resistance genes, which contribute to cUTIs in pediatrics.

Highlights

Urinary tract infections (UTIs) are a public health problem in Mexico and the second leading cause of morbidity worldwide
We evaluated the resistance profile against 10 antibiotic categories, β-lactamase phenotype expression [ESBL and Metallo-β-Lactamase (MBL)], integron classes (1 and 2), and frequency of 17 virulence genes to analyze genetic diversity using pulsedfield gel electrophoresis (PFGE) and multilocus sequence typing (MLST; sequence type (ST) and CCs) in a set of clinical strains of serogroup O25b Uropathogenic Escherichia coli (UPEC) recovered from children with complicated UTIs (cUTIs) from the Hospital of Mexico Federico Gomez (HIMFG)
A total of 129 clinical strains of UPEC O25b were recovered from patients with cUTIs who were hospitalized in various service areas of the HIMFG from 2009 to 2018

Summary

Introduction

Urinary tract infections (UTIs) are a public health problem in Mexico and the second leading cause of morbidity worldwide. UPEC is the causative agent of more than 80% of community-acquired cystitis, more than 70% of uncomplicated acute pyelonephritis, and 3.6–12.6% of complicated UTIs (cUTIs) with urosepsis [2]. Clinical strains of UPEC belonging to serogroup O25 (UPEC O25) have been reported in various populations, including adult patients hospitalized with symptomatic UTIs [4], adult patients with community-associated. Uropathogenic Escherichia coli (UPEC) has increased the incidence of urinary tract infection (UTI). It is the cause of more than 80% of community-acquired cystitis cases and more than 70% of uncomplicated acute pyelonephritis cases. Aim: The present study describes the molecular epidemiology of UPEC O25b clinical strains based on their resistance profiles, virulence genes, and genetic diversity.

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Results

Discussion

Conclusion