Abstract
Extended Spectrum β-Lactamases (ESBLs) confer resistance to third-generation cephalosporins and CTX-M types have emerged as the most prominent ESBLs worldwide. This study was designed to determine the prevalence of CTX-M positive ESBL-producing urinary E. coli isolates from HIV patients and to establish the association of multidrug resistance, phylogeny, and virulence profile with CTX-M production. A total of 57 ESBL producers identified among 76 E. coli strains isolated from HIV patients from South India were screened for bla CTX-M, AmpC production, multidrug resistance, and nine virulence associated genes (VAGs), fimH, pap, afa/dra, sfa/foc, iutA, fyuA, iroN, usp, and kpsMII. The majority (70.2%) of the ESBL producers harbored bla CTX-M and were AmpC coproducers. Among the CTX-M producers, 47.5% were found to be UPEC, 10% harbored as many as 7 VAGs, and 45% possessed kpsMII. Multidrug resistance (CIPRSXTRGENR) was significantly more common among the CTX-M producers compared to the nonproducers (70% versus 41.2%). However, 71.4% of the multidrug resistant CTX-M producers exhibited susceptibility to nitrofurantoin thereby making it an effective alternative to cephalosporins/fluoroquinolones. The emergence of CTX-M-producing highly virulent, multidrug resistant uropathogenic E. coli is of significant public health concern in countries like India with a high burden of HIV/AIDS.
Highlights
Uropathogenic Escherichia coli (UPEC), a subset of the extraintestinal pathogenic E. coli (ExPEC), is the principal etiological agent of community onset urinary tract infection (UTI) accounting for substantial morbidity and medical costs worldwide
Compared with the CTX-M nonproducers, CTX-M-producing isolates were found to be significantly enriched for kpsMII (p = 0.048), while no statistical difference was observed in the incidence of other virulence associated genes (VAGs)
CTX-M-producing E. coli has emerged worldwide as the leading cause of community onset of UTI in the era of antibiotic resistance [26]. In line with these findings, we report that 70.2% of the ESBL-producing E. coli isolates recovered from HIV patients with UTI were found to harbor blaCTX-M which is a matter of concern
Summary
Uropathogenic Escherichia coli (UPEC), a subset of the extraintestinal pathogenic E. coli (ExPEC), is the principal etiological agent of community onset urinary tract infection (UTI) accounting for substantial morbidity and medical costs worldwide. Recent studies have shown that ExPEC isolates have increasingly become resistant to the frontline antibiotics including the cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole [1]. ESBL mediated resistance has been increasingly reported among urinary Escherichia coli isolated from HIV patients in India [3, 4]. ESBL-producing isolates, especially CTX-M-producing E. coli, exhibit an alarming trend in coresistance to other classes of antibiotics [5,6,7]. Previous studies have reported that multidrug resistant E. coli strains are significantly associated with decreased virulence, non-B2 phylogenetic lineage, and host immunocompromised status [8, 9]. Many studies have documented a strong association between CTX-M production and decreased virulence [10,11,12].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
