Enteroaggregative Escherichia coli is associated with antibiotic resistance and urinary tract infection symptomatology

Abstract

Background Uropathogenic Escherichia coli (UPEC) is the causative agent of uncomplicated urinary tract infections (UTIs) in ambulatory patients. However, enteroaggregative E. coli (EAEC), an emergent bacterial pathogen that causes persistent diarrhoea, has recently been associated with UTIs. The aim of this study was to determine the frequency of EAEC virulence genes, antibiotic resistance, as well as biofilm production of UPEC isolates obtained from ambulatory patients with non-complicated UTIs that attended to the ISSSTE clinic in Chilpancingo, Guerrero, Mexico, and correlate these with the patients’ urinary tract infection symptomatology. Methods One hundred clinical isolates were obtained. The identification of clinical isolates, antimicrobial susceptibility testing, and extended spectrum beta-lactamases (ESBLs) production were performed using the Vitek automated system. Assignment of E. coli phylogenetic groups was performed using the quadruplex phylo-group assignment PCR assay. UPEC virulence genes (hlyA, fimH, papC, iutA, and cnf1) and EAEC virulence genes (aap, aggR, and aatA) were detected by multiple PCR. Results We found that 22% of the isolates carried the aggR gene and were classified as UPEC/EAEC. The main phylogenetic group was B2 (44.1% were UPEC and 77.27% UPEC/EAEC isolates, respectively). Over half of the UPEC/EAEC isolates (63.64%) were obtained from symptomatic patients, however the aatA gene was the only one found to be associated with the risk of developing pyelonephritis (OR = 5.15, p = 0.038). A total of 77.71% of the UPEC/EAEC isolates were ESBL producers and 90.91% multidrug-resistant (MDR). In conclusion, UPEC/EAEC isolates are more frequent in symptomatic patients and the aatA gene was associated with a higher risk of developing pyelonephritis, along with UPEC genes hlyA and cfn1. UPEC/EAEC isolates obtained from UTI showed ESBL production and MDR.

A novel chaperone-effector-immunity system identified in uropathogenic Escherichia coli UMN026

“…We found that the genes were present not only in isolates from symptomatic but also from asymptomatic patients. We also found that these genes are more frequent in phylogroups B2, D, and F. The difference between our results and those reported by Nielsen et al may be explained because we included patients with AB, as well as patients with ailments (type 2 diabetes mellitus, pregnancy, catheter, and chronic renal illness) ( Martinez-Santos et al, 2021 ).…”

“…Some UPEC virulence factors, such as Cnf1 and HlyA, have been associated with UTI symptoms ( Martinez-Santos et al, 2021 ); therefore, we analyzed whether there was any relationship between the expression of the ECUMN genes and disease symptoms. Interestingly, we found no relationship.…”

“…A total of 99 previously isolated UPEC clinical isolates were used ( Martinez-Santos et al, 2021 ). The reference strains and clinical isolates used for RT-PCR and antibacterial activity assays are described in Table 1 .…”

Characterization of Uropathogenic Escherichia coli Reveals Hybrid Isolates of Uropathogenic and Diarrheagenic (UPEC/DEC) E. coli

“…Data on the resistance profile of hybrid UPEC/EAEC and UPEC/aEPEC isolates are scarce in the literature. However, a very recently published article characterizing UPEC isolates obtained from 100 ambulatory patients with community-acquired UTIs in the city of Chilpancingo, Mexico, reported that 77.27% (17/22) of the UPEC/EAEC hybrid isolates studied were classified as ESBL producers, besides the high resistance rates observed for β-lactams, aminoglycosides, quinolones/fluoroquinolones, and folic acid metabolism inhibitors [ 73 ]. Moreover, a hybrid UPEC/aEPEC identified as an ESBL-producer, and harboring the bla CTX-M-15 gene, was reported as a causative agent of UTI in Brazil [ 47 ].…”

Genomic Evidence for Extra-Intestinal Foodborne Disease due to Zoonotic Bacteria: A Public Health Risk

“…In 2015, the World Health Organization (WHO) published the first estimates of FBD worldwide reporting that E. coli caused over 110 million cases of FBD resulting in over 63,000 deaths (WHO, 2015). Diarrhoeagenic E. coli (DEC) pathotypes including enteropathogenic (EPEC) and atypical EPEC (lacking the bundle-forming pilus), enterotoxigenic (ETEC), enteroaggregative (EAEC), diffusely adherent (DAEC) entero-invasive (EIEC), and Shiga toxin-producing E. coli (STEC), are important causes of diarrhoea in children, of travellers’ diarrhoea (TD), and diarrhoea in immunocompromised patients (Martínez-Santos et al, 2021). STEC can be specifically associated with haemolytic uremic syndrome, while ETEC and EAEC with TD (Cabrera-Sosa & Ochoa, 2020; Jiang & DuPont, 2017).…”