Virulence factors and antimicrobial resistance of uropathogenic Escherichia coli (UPEC) isolated from urinary tract infections: a systematic review and meta-analysis

Gabriel Kambale Bunduki,Janelisa Musaya,Nicholas Feasey,Eva Heinz,Vincent Samuel Phiri,Patrick Noah

doi:10.1186/s12879-021-06435-7

Abstract

BackgroundUropathogenic Escherichia coli (UPEC) are amongst the most frequent causes of urinary tract infections. We report a systematic review and meta-analysis of virulence factors and antimicrobial resistance of UPEC isolated from urinary tract infections.MethodsA systematic review and meta-analysis were performed using PRISMA guidelines (Research Registry ref. 5874). Data were extracted from PubMed/MEDLINE and ScienceDirect databases for studies published from January 1, 2000 to December 31, 2019. Studies reporting antimicrobial resistance and virulence factors of UPEC isolated in confirmed urinary tract infections (≥105CFU/ml) were eligible. Prevalence of antimicrobial resistance and virulence factors of UPEC were estimated using random-effects meta-analysis model. Estimates with 95% confidence intervals, I-square (I2) statistic, and Cochran’s Q test were computed using the score statistic and the exact binomial method by incorporating the Freeman-Tukey double arcsine transformation of proportions.ResultsOur search returned 2504 hits, of which 13 studies were included in the meta-analysis, totalling 1888 UPEC isolates. Highest antimicrobial resistance rates were observed among the antibiotic class of tetracycline in 69.1% (498/721), followed by sulphonamides in 59.3% (1119/1888), quinolones in 49.4% (1956/3956), and beta-lactams in 36.9% (4410/11964). Among beta-lactams, high resistance was observed in aminopenicillins in 74.3% (1157/1557) and first generation cephalosporins in 38.8% (370/953). Meanwhile, virulence factors with highest prevalence were immune suppressors (54.1%) followed by adhesins (45.9%). Taken individually, the most observed virulence genes were shiA (92.1%), CSH (80.0%), fimH/MSHA (75.3%), traT (75.1%), sisA (72.2%), iucD (65.7%), iutA (61.8%), kpsMTII (60.6%), and PAI (55.2%).ConclusionsThe increased antibiotic resistance of UPEC isolates was demonstrated and suggested a need for reassessment of empirical therapies in urinary tract infections treatment caused by this pathogen. In addition, this pathotype exhibited diverse surface and secreted virulence factors.

Highlights

Uropathogenic Escherichia coli (UPEC) are amongst the most frequent causes of urinary tract infections
Search strategy The electronic bibliographic databases PubMed/MEDLINE and ScienceDirect were searched in all fields with the search terms combined as follow: Virulence factors OR virulence AND factors OR virulence factors AND associated AND anti-infective agents OR anti-infective agents OR anti-infective AND agents OR anti-infective agents OR antimicrobial AND resistance AND uropathogenic Escherichia coli OR uropathogenic AND Escherichia AND coli OR uropathogenic Escherichia coli AND UPEC
Among the 13 studies included in the meta-analysis, one reported in- and outpatient UPEC but did not distinguish the two categories while reporting the antimicrobial resistance rate [20], and was considered as a single study in the metaanalysis

Summary

Introduction

Uropathogenic Escherichia coli (UPEC) are amongst the most frequent causes of urinary tract infections. We report a systematic review and meta-analysis of virulence factors and antimicrobial resistance of UPEC isolated from urinary tract infections. Antimicrobial resistance (AMR) has increasingly been reported in bacteria causing urinary tract infections (UTI) during the last few decades and has become a major public health concern [1]. The most common cause of UTI is Escherichia coli [2], a ubiquitous gram negative pathogen and member of the family Enterobacteriaceae. E. coli typically acquires AMR genes through mobile genetic elements (MGE), such as plasmids, insertion sequences, transposons, and gene cassettes/integrons [4]. A large number of resistance-encoding mobile elements, in particular plasmids, are shared between different members of the Enterobacteriaceae and further promote the spread of resistance genes [5]. MGE can encode for virulence factors, and there may be interplay between virulence and antimicrobial resistance [4]

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