Antibiotic resistance, phylogenetic typing, and virulence genes profile analysis of uropathogenic Escherichia coli isolated from patients in southern Iraq

Of the most common infectious diseases that occur mainly by uropathogenic Escherichia coli (UPEC) is urinary tract infections (UTIs). The purpose of this study was to investigate virulence factors, antibiotic resistance, and phylogenetic groups among UPEC strains isolated from patients with UTI in southern Iraq. A total of 100 UPEC isolates were collected from urine samples of UTI patients from various hospitals in southern Iraq, and confirmed by morphological and biochemical tests. Antimicrobial susceptibility testing on isolates was performed by disk diffusion method. Multiplex PCR techniques were used to evaluate the phylogenetic groups based on Clermont method and to detect the presence of six virulence factor genes. The majority of isolates belonged to the phylogenetic groups B2 (46%) and C (13%). The most prevalent virulence factors were fimH (96%), followed by aer (47%), papC (36%), cnf1 (17%), hly (15%), and afa (8%). Phenotypic testing showed that the isolates were most resistant to piperacillin, ticarcillin, amoxicillin/clavulanic acid (92%, 91%, and 88%, respectively) and most sensitive to amikacin and imipenem, respectively. The maximum antibiotic resistance and virulence factors were observed in the phylogenetic group B2. The results showed that the UPEC isolates had all six virulence factors with high frequency and the highest drug resistance. Besides, the results showed a direct relationship between virulence factors, gene diversity, phylogenetic background, and antimicrobial resistance in the UPEC isolates.

Antimicrobial resistance patterns and integron carriage of Escherichia coli isolates causing community-acquired infections in Turkey

We aimed to observe antimicrobial resistance patterns and integron carriage of Escherichia coli isolates causing community-acquired infections. Two hundred sixty-eight E. coli strains were obtained from outpatients with various infections at different polyclinics at the 82nd Year of State Hospital in Rize, Turkey. Susceptibility to antimicrobials was tested using a disk diffusion method. The presence of integrons was examined using PCR with specific primers. Positive PCR results were confirmed by sequencing. A broth mating method was used for conjugation assays. Extragenic palindromic-PCR was performed using the oligonucleotide primer BOXA1R. Resistance frequency for ampicillin, trimethoprim/sulfamethoxazole, and tetracycline was determined as 50.6%, 33.5%, and 36.8% respectively. No strains were resistant to amikacin. Seventy isolates were positive for the intI1 gene, of which 49 carried gene cassettes. Eleven isolates were positive for the intI2 gene, eight of which carried gene cassettes. Seven gene cassettes (dfrA1, dfrA5, dfrA7, dfrA17, aadA1, aadA5, and sat2) were predominantly harbored in integrons. We detected conjugative plasmids harboring integrons in two E. coli strains. Four strain clusters were yielded by BOX-PCR fingerprints showing that they were clonally related. No apparent relationship occurred among class 1 and 2 integron-carrying strains. We conclude that integrons are widespread in genetically variable E. coli strains and will continue to mediate dissemination of resistance genes in the community.

Uropathogen resistance to antibiotic prophylaxis in urinary tract infections

Young children at risk of recurrent urinary tract infections are prescribed long-term antibiotic prophylaxis to prevent recurrences. As this is associated with an increased risk of resistant infections, we have analyzed the pattern of uropathogen resistance to the prescribed prophylactic antibiotic during a urinary tract infection recurrence. A cohort of 36 children aged 2 weeks to 10 years. Antimicrobial susceptibility of the isolates was tested by the disc diffusion technique. The majority were on prophylaxis with cefradine (n = 19, 53%) or cotrimoxazole (n = 11, 31%). Escherichia coli was the commonest grown organism (n = 26, 72%). Resistance occurred in 19 children (53%), with the highest for amoxicillin-clavulanate (n = 2, 100%) and nalidixic acid (n = 1, 100%), followed by cefradine (n = 10, 72%), cotrimoxazole (n = 5, 62%), and aminopenicillins (n = 1, 50%). Multidrug resistance occurred in 20 (55.5%) more commonly with cephalosporins (60% of cases) and cotrimoxazole (20%). Uropathogen resistance to prophylactic antibiotics occurs in 50% of the cases, half of which to multidrugs. Compliance to long-term prophylaxis seems to remain an important problem in the children where there was no resistance to the prescribed antibiotic.