Predisposition of Blood group Non-secretors to Urinary tract infection with Escherichia coli Anti-microbial Resistance and Acute Kidney Injury

Abstract

Urinary tract infection (UTI) causes significant renal damage and disease severity is compounded by antimicrobial resistance (AMR) and other comorbidities in the patient. Blood group antigens secreted in body fluids (secretor status) are known to play a role in bacterial adhesion and we studied its influence on AMR in UTI. A total of 2758 patients with UTI were studied with urine culture, qualitative and semiquantitative urine microscopy, serum creatinine and secretor status in saliva samples by adsorption-inhibition method. Of these, AMR from 300 patients with E. coli infection were assessed as per CLSI 2019 guidelines and extended-spectrum beta-lactamase (ESBL) genes (bla TEM, bla CTX-M, bla SHV) and NDM1 genes were studied using TaqMan probes in Real-time polymerase chain reaction. Patients with UTI were followed up for two weeks. Female patients had higher predilection (57%) for E. coli infection while patients with diabetes or non-secretors had none. In our study, ESBL producers were seen in 62% of the E. coli isolates and fosfomycin had 100% susceptibility. Non-secretors were significantly associated with acute kidney injury (AKI), AMR and ESBL genes. Multidrug-resistant (MDR) was noted in 127/160 (79.4%) ESBL and 17/18 (94%) NDM1 gene encoding strains. Quantitative urine microscopy scoring predicted AKI both at presentation and at end of follow up. ESBL producers were common in our study population and non-secretors had a significant association with AMR genes. Urine microscopy scoring system may be a useful tool to predict AKI in patients with UTI.

Urine Microscopy Score and Neutrophil Lymphocyte Ratio at Presentation are Good Biomarkers of Acute Kidney Injury in Patients with Upper Urinary Tract Infection when Assessed in Correlation with Virulence Factors of Escherichia coli and Blood Group Secretor Status

“…Detailed patient demographics and clinical presentation of the patient is cited in our earlier publication, studying the antibiotic resistance in the same subset. 7 Patients in the study (n=300) had upper UTI due to E.coli, as defined by clinical symptoms and among them, 99 patients (33%) had AKI at initial presentation, as per KDIGO guidelines. At the end of 14 days follow-up, 60 patients (20%) had persistent AKI.…”

“…Genes coding for virulence factors of E. coli viz., type 1 fimbriae (fimH), P fimbriae (papA), serum resistance (iss), hemolysin (hlyA), cytotoxic necrotising factor (cnf1), curli fimbriae (csgA) and biofilm (iutA), were identified using TaqMan probes designed by Helini Biomolecules, India, based on sequences from NCBI (Table 1), following the methodology as detailed in our earlier publication. 7 Real-time thermal cycler from ABI QS3 was utilized with in-built blanks (negative controls) and positive commercial controls for every run. Concordance with a mean ct value of three thermal cycler runs was used to identify virulence genes.…”

“…6 AKI due to upper UTI, is significantly affected by the virulence of bacteria as well as the anti-bacterial resistance. 7 There are several virulence factors in UPEC which are attributed to the pathogenesis and impact the disease severity such as adhesion factors, toxin production etc.…”