Abstract
Carbapenems are the last resort antimicrobials for the treatment of extended spectrum β-lactamases (ESBLs) producing Enterobacteriaceae. Emergence of carbapenems resistant group B2 uropathogenic E. coli (UPEC) is a major concern because of their high virulence. Prevalence of these enzymes and multidrug resistance (MDR) among B2 UPEC isolates from Iraqi outpatients with acute urinary tract infection (UTI) was evaluated in this research. Urine cultures were performed and the isolates were identified biochemically. Escherichia coli isolates were tested for phylogroup reference by quadraplex PCR, then B2 isolates were detected for antimicrobial resistance by disc diffusion test and carbapenemase genes by PCR. Escherichia coli was the most prevalent among Gram-negative isolates (66.6%) and B2 was the most detected phylogroup among E. coli isolates (33.9%). Most of B2 isolates showed high resistance rates to tested antimicrobials, especially β-lactams with MDR revealed in 100% of them. Whereas, low resistance rates were noted against carbapenems, aminoglycosides and nitrofurantoin. Carbapenemase genes were detected in 76.3% of B2 isolates. Of which, blaOXA-48 was the most frequent (57.8%), followed by blaPER (47.3%), blaKPC (15.7%), blaVEB and blaVIM (10.5%, for each). Whereas, blaGES and blaIMP genes were not found. Coproduction of these genes occurred among 17 isolates. The combination of blaOXA-48 and blaPER was the most frequent (41.1%). All carbapenemase producing isolates were MDR. These results revealed high prevalence of carbapenemase genes and MDR among B2 UPEC recovered in this study. In the study area. it is strongly advised to use aminoglycosides and nitrofurantoin for empirical treatment of UPEC.
Highlights
Escherichia coli (E. coli) is the most versatile known microorganism [1]
Escherichia coli was the most commonly isolated species among Gram-negative bacteria (112/168: 66.6%), followed by K. pneumoniae (28: 16.6%), Proteus mirabilis (P. mirabilis) and Pseudomonas spp. (11: 6.5%, for each) and Enterobacter spp. (6: 3.5%). These results were similar to those obtained by other Iraqi researchers such as that which was carried out in Kirkuk city by Alsamarai and Ali [32] where they showed 41.6% of urine samples were culture positive and E. coli was the predominantly isolated bacteria (57.7%), followed by K. pneumoniae (14.5%), and Proteus spp. (10.3%)
Similar results were reported from other countries as those achieved by Rafalskiy et al [34] in the Russian Federation where they found that 64.2% of the isolated uropathogens were Gramnegative and E. coli was the most prevalent (49.1%), followed by K. pneumoniae (9.5%), P. mirabilis (2.9%), P. aeruginosa (1.7%) and Enterobacter spp. (1.0%)
Summary
Escherichia coli (E. coli) is the most versatile known microorganism [1]. It is a common commensal of gastrointestinal tract of human and animal. The main infections caused by ExPEC are urinary tract infections (UTIs), sepsis, meningitis, and wound infections [2,3,4]. A large proportion of humans are affected by UTIs, with annual prevalence of about 150 million cases. Uropathogenic E. coli is the most prevalent ExPEC and it is the primary cause of UTIs all over the world [3]. Uropathogenic E. coli strains have a wide variety of virulence factors which include: immune suppressors, adhesins (fimbrial and afimbrial adhesins), siderophore systems, the serum resistance, the capsular polysaccharide K antigen, and toxins [3, 5]
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