Abstract
BackgroundUropathogenic Escherichia coli (UPEC) is a major cause of urinary tract infection (UTI); however, treatment of UTI has been challenging due to increased antimicrobial resistance (AMR). One of the most important types of AMR is carbapenem resistance (CR). CR bacteria are known as an important threat to global public health today. Class B metallo-beta-lactamases (MBLs) are one of the major factors for resistance against carbapenems. We aimed to investigate the characteristics of UPEC isolates producing MBL.MethodsA cross-sectional study was conducted from October 2018 to December 2019 in Ahvaz; Iran. UPEC isolates were identified by biochemical and molecular methods. Metallo-beta-lactamase-producing isolates were detected using modified carbapenem inactivation method (mCIM) and EDTA-CIM (eCIM) tests. MBL genes, phylogenetic group, and virulence genes profile of carbapenem resistant isolates were determined. Conjugation assay and plasmid profiling were conducted to evaluate the ability of transferring of CR to other E. coli isolates. Clonal similarity of isolates were assessed using Enterobacterial intergenic repetitive element sequence (ERIC)-PCR.ResultsAmong 406 UPEC isolates, 12 (2.95%) carbapenem-resistant were detected of which 11 were phenotypically MBL-producing strains. Four isolates were resistant to all investigated antimicrobial agents and were considered possible pandrug-resistant (PDR). blaNDM, blaOXA-48, blaIMP-1, and blaIMP-2 genes were found in 9, 5, 1, and 1 isolates, respectively. Among 30 virulence genes investigated, the traT, fyuA followed by fimH, and iutA with the frequency of 8 (66.7%), 8 (66.7%), 7 (58.3%), and 7 (58.3%) were the most identified genes, respectively. Siderophore production was the main virulence trait among carbapenem-resistant UPEC isolates. Except for two, all other isolates showed weak to moderate virulence index. In all recovered isolates, CR was readily transmitted via plasmids to other isolates during conjugation experiments.ConclusionMBL and carbapenemase genes, especially blaNDM and blaOXA-48 are spreading rapidly among bacteria, which can be a threat to global public health. Therefore monitoring the emergence and dissemination of new AMR is necessary to continuously refine guidelines for empiric antimicrobial therapy. Understanding the mechanisms of resistance and virulence in this group of bacteria can play an effective role in providing new therapeutic methods.
Highlights
Urinary tract infection (UTI) is one of the most common infectious diseases that affects people of all ages
Five isolates were Extensively-drug resistant (XDR) meaning non-susceptible to at least one drug in all but two or fewer antibiotic or antimicrobial family [8], 4 (1%) isolates were possible PDR meaning were non-susceptible to all investigated antimicrobial categories [8]
We found two reports about the presence of blaIMP among E. coli strains in northern Iran and Tehran [61, 62]. blaOXA-48, which is class D carbapenemase, was detected in five carbapenemresistant Uropathogenic Escherichia coli (UPEC) isolates
Summary
Urinary tract infection (UTI) is one of the most common infectious diseases that affects people of all ages. The main etiologic agent causing UTI is a group of Escherichia coli strains that named uropathogenic Escherichia coli (UPEC) [1]. UPEC strains are capable to colonize and invade urogenital tract which eventually leads to infection of urinary tract system. Disease establishment is caused by virulence factors (VFs) of bacteria and host characteristics [2, 3]. VFs may be present in the chromosome or acquired horizontally through mobile genetic elements such as transposons, plasmids, and pathogenicity islands, thereby leading to great diversity among UPEC strains [5, 6]. Uropathogenic Escherichia coli (UPEC) is a major cause of urinary tract infection (UTI); treatment of UTI has been challenging due to increased antimicrobial resistance (AMR). Class B metallo-beta-lactamases (MBLs) are one of the major factors for resistance against carbapenems. We aimed to investigate the characteristics of UPEC isolates producing MBL
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