Antibiotic Susceptibility and Molecular Characterization of Uropathogenic Escherichia coli Associated with Community-Acquired Urinary Tract Infections in Urban and Rural Settings in South Africa

Abstract

We investigated the phenotypic and genotypic antibiotic resistance, and clonality of uropathogenic Escherichia coli (UPEC) implicated in community-acquired urinary tract infections (CA-UTIs) in KwaZulu-Natal, South Africa. Mid-stream urine samples (n = 143) were cultured on selective media. Isolates were identified using the API 20E kit and their susceptibility to 17 antibiotics tested using the disk diffusion method. Extended-spectrum β-lactamases (ESBLs) were detected using ROSCO kits. Polymerase chain reaction (PCR) was used to detect uropathogenic E. coli (targeting the papC gene), and β-lactam (blaTEM/blaSHV-like and blaCTX-M) and fluoroquinolone (qnrA, qnrB, qnrS, gyrA, parC, aac(6’)-Ib-cr, and qepA) resistance genes. Clonality was ascertained using ERIC-PCR. The prevalence of UTIs of Gram-negative etiology among adults 18–60 years of age in the uMgungundlovu District was 19.6%. Twenty-six E. coli isolates were obtained from 28 positive UTI samples. All E. coli isolates were papC-positive. The highest resistance was to ampicillin (76.9%) and the lowest (7.7%) to amoxicillin/clavulanic acid and gentamycin. Four isolates were multidrug-resistant and three were ESBL-positive, all being CTX-M-positive but SHV-negative. The aac(6’)-Ib-cr and gyrA were the most detected fluoroquinolone resistance genes (75%). Isolates were clonally distinct, suggesting the spread of genetically diverse UPEC clones within the three communities. This study highlights the spread of genetically diverse antibiotic-resistant CA-UTI aetiologic agents, including multidrug-resistant ones, and suggests a revision of current treatment options for CA-UTIs in rural and urban settings.

Etiology and prevalence of ESBLs in adult community-onset urinary tract infections in East China: A prospective multicenter study

“…coli is recognized as the predominant uropathogen in UTIs, accounting for 75%-95% of all UTIs all over the world. 9 Similarly, in the present study, we revealed that E. coli is the major pathogen of COUTIs in China, accounting for about three quarters of all the causative pathogens.…”

Trends in the epidemiology of urinary tract infections in pregnancy at a tertiary hospital in Johannesburg: Are contemporary treatment recommendations appropriate?

“…The common pathogens identified in this study are in general consistent with the findings of other recently published South African studies. 6 , 14 , 15 The relatively high number of E. faecalis infections (2016: 17.4%) in this study is similar to that seen in the pooled 2015–2019 data for four Gauteng tertiary centres (including CMJAH) but higher than that reported for 2011–2016 in KZN (4.2%). The second most common pathogen in KZN was K. pneumoniae .…”

Molecular Epidemiology of Human Papillomaviruses, Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium among Female Sex Workers in Burkina Faso: Prevalence, Coinfections and Drug Resistance Genes

“…HPV is the leading cause of cervical cancer, which is the leading cause of cancer death in women in Africa. It is therefore a real public health problem, especially because some of the circulating genotypes are not covered by existing and available vaccines [16][17][18]. Pathogens such as NG, MG and CT would promote HPV infection which in turn could persist and induce precancerous lesions or cervical intraepithelial neoplasia type 1, 2 or 3 (CIN1, CIN2 and CIN3), which may regress or progress to cervical cancer.…”

“…DNA extraction was performed at CERBA/LABIOGENE using the DNA-Sorb-A kit from SACACE Biotechnologies ® (Reference K-1-1/A/100, Lot 23B16A155), following the protocol provided by the manufacturer. For the molecular diagnosis of HPV, the "HPV Genotypes 14 Real-TM Quant" real-time amplification kit from SACACE Biotechnologies ® (Reference V67-100FRT, Lot 26 G17K414) detecting 14 high-risk HPV genotypes was used (HPV 16,18,31,33,35,39,45,51,52,56,58,59,66.68). PCR was performed using the SaCycler-96 real-time PCR device in version 7.3 of SACACE Biotechnologies ® .…”