Antibiotic Resistance, Phylogenetic Typing and Virulence Genes Profile Analysis of Uropathogenic Escherichia Coli Isolated From Patients in Southern Iraq

Abstract

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 technique was used to evaluate the phylogenetic groups and the presence of six virulence factor genes; type 1 fimbria (fimH), A-fimbrial adhesion (afa), hemolysin (hly), fimbrial adhesins P (papC), cytotoxic necrosis factor 1 (cnf1), and aerobactin (aer). The majority of isolates belonged to the phylogenetic groups of B2 (55%) and D (32%). 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.