Phylogenetic Group Distribution of Uropathogenic Escherichia coli and Related Antimicrobial Resistance Pattern: A Meta-Analysis and Systematic Review.

Mehrdad Halaji,Mehdi Rajabnia,Donya Zare,Abazar Pournajaf,Reza Ranjbar,Amirhossein Fayyazi

doi:10.3389/fcimb.2022.790184

Abstract

The phylogenetic classification of Escherichia coli isolates is of great importance not only for understanding the populations of E. coli but also for clarifying the relationship between strains and diseases. The present study aimed to evaluate the prevalence of phylogenetic groups, antibiotic susceptibility pattern, and virulence genes among uropathogenic E. coli (UPEC) isolated from different parts of Iran through a systematic review and meta-analysis. Several international electronic sources, including Web of Science, PubMed, Scopus, and Embase, were searched (2000–2020) in order to identify the studies compatible with our inclusion criteria. The meta-analysis was performed using the metaprop program in the STATA (version 11) software. Based on our comprehensive search, 28 studies meeting the eligibility criteria were included in the meta-analysis. The pooled prevalence of phylogroups B2, D, B1, and A was 39%, 26%, 18%, and 8%, respectively. In addition, there was a significant heterogeneity among different phylogroups. However, according to the results of Begg’s and Egger’s tests, there were no significant publication bias in phylogroups B2, D, B1, and A. This research provided the first comprehensive study on phylogroups of UPEC isolated in Iran. Our findings indicated that phylogroup B2 and group D were the most predominant phylogenetic groups among UPEC isolates in various regions of Iran. In addition, we observed that certain phylogenetic groups are more antibiotic resistant than the others. It was also observed that the dissemination of virulent phylogroup B2 and D should be controlled via comprehensive infection control measures. Additionally, certain strategies should be developed for monitoring the antibiotic therapy.

Highlights

Urinary tract infections (UTI), as one of the most prevalent pathological disorders, are the most problematic infectious diseases worldwide in both community and hospital settings (Terlizzi et al, 2017)
The articles with the following criteria were included in the study: (1) cross-sectional, retrospective, and cohort studies indexed in the Web of Science or PubMed or Scopus database and reporting the prevalence of phylogenetic groups in E. coli isolates collected from the urine of patients with UTI and (2) those published worldwide with available English abstracts
Phylogenetic analysis indicated that the majority of Uropathogenic Escherichia coli (UPEC) isolates belonged to phylogroup B2 (39%), followed by group D (26%), group A, and group B1, which is in agreement with the study conducted by Munkhdelger et al (2017), where B2 (33.8%) was the dominant phylogroup followed by D (28.4%), A (19.6%), and B1 (18.2%)

Summary

Introduction

Urinary tract infections (UTI), as one of the most prevalent pathological disorders, are the most problematic infectious diseases worldwide in both community and hospital settings (Terlizzi et al, 2017). UTI patients could be categorized into symptomatic and asymptomatic cases. It is known that Uropathogenic Escherichia coli (UPEC) is the main factor causing UTIs (Navidinia et al, 2018). The primary cause of UTIs is UPEC, both in community and hospital settings, which leads to a considerable rate of global mortality and morbidity (Tabasi et al, 2015). Antibiotic therapy is the only treatment for UTI; global spread of MDR bacterial strains has become a public health threat and major concern, in patients with recurrent UTIs (Halaji et al, 2020; Sadeghi et al, 2020). Excessive use of a broad spectrum of antibiotics, such as fluoroquinolones, cephalosporins, and aminoglycosides, raise the cost of treatment and hospitalization (Fayyazi et al, 2020)

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