Journal Article

Multidrug resistance among uropathogenic clonal group A E. Coli isolates from Pakistani women with uncomplicated urinary tract infections

Bokhari, Habib, Khan, Ayesha, Batool, Tahira, Siddiqui, Fariha, Javed, Sundus, Alonazi, Wadi B., Saraf, Viqar Sayeed, Ibrahim, Muhammad, Pucciarelli, Sandra, Noreen, Zobia, Ahmad, Aftab

2024

Overview

Objective Multi-drug resistance (MDR) has notably increased in community acquired uropathogens causing urinary tract infections (UTIs), predominantly Escherichia coli . Uropathogenic E. coli causes 80% of uncomplicated community acquired UTIs, particularly in pre-menopausal women. Considering this high prevalence and the potential to spread antimicrobial resistant genes, the current study was conducted to investigate the presence of clinically important strains of E. coli in Pakistani women having uncomplicated cystitis and pyelonephritis. Women belonging to low-income groups were exclusively included in the study. Seventy-four isolates from urine samples were processed, phylotyped, and screened for the presence of two Single Nucleotide Polymorphisms (SNPs) particularly associated with a clinically important clonal group A of E. coli (CgA) followed by antibiotic susceptibility testing and genome sequence analysis. Results Phylogroup B2 was most prevalent in patients and 44% of isolates were positive for the presence of CgA specific SNPs in Fumarate hydratase and DNA gyrase subunit B genes. Antibiotic susceptibility testing showed widespread resistance to trimethoprim-sulfamethoxazole and extended-spectrum beta-lactamase production. The infection analysis revealed the phylogroup B2 to be more pathogenic as compared to the other groups. The genome sequence of E. coli strain U17 revealed genes encoding virulence, multidrug resistance, and host colonization mechanisms. Conclusions Our research findings not only validate the significant occurrence of multidrug-resistant clonal group A E. coli (CgA) in premenopausal Pakistani women suffering from cystitis and pyelonephritis but also reveal the presence of genes associated withvirulence, and drug efflux pumps. The detection of highly pathogenic, antimicrobial-resistant phylogroup B2 and CgA E. coli strains is likely to help in understanding the epidemiology of the pathogen and may ultimately help to reduce the impact of these strains on human health. Furthermore, the findings of this study will particularly help to reduce the prevalence of uncomplicated UTIs and the cost associated with their treatment in women belonging to low-income groups.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Anti-Bacterial Agents - pharmacology / Anti-Bacterial Agents - therapeutic use / Antibiotics / Biological Microscopy / Biomedical and Life Sciences / Causes of / Cystitis / Cystitis - drug therapy / DNA topoisomerase / Drug resistance / Drug resistance in microorganisms / Drug Resistance, Multiple / Drug therapy / E coli / Efflux / Epidemiology / Escherichia coli / Escherichia coli Infections - diagnosis / Female / Fumarase / Galleria infection model / Genes / Genetic aspects / Genomes / Health care / Hospitals / Humans / Identification and classification / Life Sciences / Low income groups / Low-income group / Microbiology / Multidrug resistance / Mycology / Nucleotide sequence / Nucleotides / Pakistan - epidemiology / Parasitology / Phylotypes / Population / Pregnancy / Premenopausal women / Premenopause / Pyelonephritis / Risk factors / Sequence analysis / Single-nucleotide polymorphism / Socioeconomic factors / Socioeconomic status / Sulfamethoxazole / Thermal cycling / Trimethoprim / Trimethoprim-sulfamethoxazole / Urinary tract / Urinary tract diseases / Urinary tract infections / Urinary Tract Infections - diagnosis / Urogenital system / Urology / Uropathogenic Escherichia coli / Virology / Virulence / Women patients / Womens health / β Lactamase