Carbapenem Resistance Profiles of Pathogenic Escherichia coli in Uganda

Abstract

Background: Escherichia coli has been implicated as one of the main etiological agents of diarrhea, urinary tract infections, meningitis and septicemia worldwide. The ability to cause diseases is potentiated by presence of virulence factors. The virulence factors influence the capacity of E. coli to infect and colonize different body systems. Thus, pathogenic E. coli are grouped into DEC strains that are mainly clustered in phylogenetic group B1 and A; ExPEC belonging to A, B2 and D. Coexistence of virulence and beta-lactamase encoding genes complicates treatment outcomes. Therefore, this study aimed at presenting the CR profiles among pathogenic E. coli. Methods: This was a retrospective cross-sectional study involving use of archived E. coli clinical isolates collected in 2019 from four Ugandan tertiary hospitals. The isolates were subjected to antibiotics sensitivity assays to determine phenotypic resistance. Four sets of multiplex PCR were performed to detect CR genes, DEC pathotypes virulent genes, ExPEC PAI and the E. coli phylogenetic groups. Results: Antibiotic susceptibility revealed that all the 421 E. coli isolates used were MDR as they exhibited 100% resistance to more than one of the first-line antibiotics. The study registered phenotypic and genotypic CR prevalence of 22.8% and 33.0% respectively. The most predominant gene was blaOXA-48 with genotypic frequency of 33.0%, then blaVIM(21.0%), blaIMP(16.5%), blaKPC(14.8%) and blaNDM(14.8%). Spearman’s correlation revealed that presence of CR genes was highly associated with phenotypic resistance. Furthermore, of 421 MDR E. coli isolates, 19.7% harboured DEC virulent genes, where EPEC recorded significantly higher prevalence (10.8%) followed by S-ETEC(3.1%), STEC(2.9%), EIEC (2.0%) and L-ETEC(2.0%). Genetic analysis characterized 46.1% of the isolates as ExPEC and only PAI IV536(33.0%) and PAI IICFT073(13.1%) were detected. Phylogenetic group B2 was predominantly detected (41.1%), followed by A(30.2%), B1(21.6%), and D(7.1%). Furthermore, 38.6% and 23.1% of the DEC and ExPEC respectively expressed phenotypic resistance.Conclusion: Our results exhibited significant level of CR carriage among the MDR DEC and ExPEC clinical isolates belonging to phylogenetic groups B1 and B2 respectively. Virulence and CR genetic factors are mainly located on mobile elements. Thus, constitutes a great threat to the healthcare system as it promotes horizontal gene transfer.

Prevalence of common carbapenemase genes and multidrug resistance among uropathogenic Escherichia coli phylogroup B2 isolates from outpatients in Wasit Province/ Iraq

“…Furthermore, nine of these 11 isolates belonged to B2 phylogroup and two were from B1 group. Most other studies [ 20 – 22 , 74 ] showed the predominance of OXA-48 among E . coli isolates, especially B2 isolates.…”

“…Furthermore, nine of these 11 isolates belonged to B2 phylogroup and two were from B1 group. Most other studies [20][21][22]74] showed the predominance of OXA-48 among E. coli isolates, especially B2 isolates. Other studies in Iraq [75] and around the world [44,[76][77][78][79][80][81][82] also revealed the occurrence of different carbapenemase genes among E. coli isolates.…”

“…As it is difficult to develop novel antimicrobial agents, efforts should be concentrated on the prevention of the spread of carbapenemase producers by early detection and reinforced hygiene measures [18] and careful monitoring of use of antimicrobials for UTI treatment is necessary [19]. In addition, predominance of carbapenemases among B2 E. coli isolates was reported from different parts of the world [20][21][22][23]. Hence, this research was designed to evaluate the prevalence of carbapenemase genes and MDR among B2 UPEC isolates from Iraqi outpatients in Wasit Province with acute UTI by multiplex PCR protocols.…”

Molecular characterization and distribution of cephalosporin resistance determinants in Escherichia coli and Klebsiella pneumoniae isolated from patients attending Kampala International University Teaching Hospital in Bushenyi, Western Uganda

“…This resistance may be attributed to the presence of resistance intrinsic factors, such as downregulation and mutation of the outer membrane proteins, through which antibiotics diffuse [41][42][43][44]. High prevalence of carbapenem resistance has been reported in Uganda [45][46][47]. Acquisition of carbapenemase encoding genes by Enterobacteriaceae confer resistance to all beta lactam antibiotics [41,45].…”

Phenotypic and Molecular Characterization of Carbapenems Resistant Escherichia coli Isolated from Patients with Urinary Tract Infections in Ardabil Province, Iran

“…However, Mahmoud et al demonstrated that bla OXA-48 and bla KPC genes were detected in 15.5% and 8.8% of the isolates, respectively ( 25 ). Ssekatawa et al from Uganda illustrated that the prevalence of bla OXA-48 , bla VIM , bla IMP , bla KPC , bla NDM genes was 33%, 21%, 16.5%, 14.8%, and 14.8%, respectively ( 32 ).…”