Antibiotic Resistance Pattern and Molecular Characterization of Resistant Genes in Escherichia Coli Isolated from Patients with Urinary Tract Infections
DOI:
https://doi.org/10.47489/szmc.v40i1.804Keywords:
Urinary Tract Infections, Escherichia coli, Antibiotic Resistance, Drug Resistance, Microbial, GenotypingAbstract
Background: The Urinary tract infection (UTI), is a critical factor in renal diseases and prevalent bacterial infection. Females have higher prevalence of UTI than males, which could be attributable to variety of physiochemical factors such as anatomic, hormonal and behavioral differences.
Objective: To evaluate the antibiotic susceptibility patterns of pathogenic bacteria and detect antibiotic-resistance genes in Escherichia coli isolated from UTI patients.
Method: This study was conducted from March to August 2024 at the Department of Biotechnology, Abdul Wali Khan University Mardan, in collaboration with the Department of Pathology, Khyber Teaching Hospital (KTH), Peshawar. Urine samples were collected from UTI patients attending the hospital. Pathogenic bacteria were isolated and identified, and antibiotic resistance genes (Mcr-2, Mcr-3, Bla-TEM, AAc(3)IV, Bla-SHV, Bla-CTX-M, aadA, astA, fanA, estB, estA, and elt) were detected in E. coli isolates. A total of 457 urine samples were collected during the study period.
Results: E. coli strains showed 75% resistance to norfloxacin and were multidrug resistant (MDR) with resistance to at least three antimicrobial agents. Several antibiotic-resistance genes, including Mcr-2, Mcr-3, Bla-TEM, Bla-CTX-M, Bla-SHV, AAc(3)IV, and aadA, were detected in the isolates. The predominant virulence gene, estB, exhibited a prevalence of 96.6% and was detected more frequently in female UTI patients (99.4%) compared to males (89.4%), showing a significant difference (P=0.0001). Both astA and estB genes were present in 99.4% of cases, with some isolates carrying 1-4 virulence genes. A significant difference in antibiotic-resistance genes between female and male UTI patients was observed.
Conclusion: The study highlights the high prevalence of multidrug-resistant E. coli and antibiotic-resistance genes among UTI patients in Peshawar, Pakistan. These findings emphasize the importance of monitoring antibiotic resistance patterns to support appropriate antimicrobial therapy for the effective management of UTIs.
References
Chan CC, Groves RA, Rydzak T, Lewis IA. Metabolomics survey of uropathogenic bacteria in human urine. Frontiers in Microbiology. 2024;15:1507561. https://doi.org/10.3389/fmicb.2024.1507561
Olier M, Sekkal S, Harkat C, Eutamene H, Theodorou V. Evaluation of reticulated gelatin-hibiscus-propolis against intestinal commensal species commonly associated with urinary tract infections. Future Microbiology. 2017;12(6):505–13. https://www.tandfonline.com/doi/full/10.2217/fmb-2016-0175
Ren Y, Palusiak A, Wang W, Wang Y, Li X, Wei H, et al. A high-resolution typing assay for uropathogenic Escherichia coli based on fimbrial diversity. Frontiers in Microbiology. 2016;7:623. https://doi.org/10.3389/fmicb.2016.00623
Umene YD, Wong LK, Satoh T, Yamane K, Matsui M, Riley LW, et al. Molecular epidemiological characterization of uropathogenic Escherichia coli from an outpatient urology clinic in rural Japan. Journal of clinical microbiology. 2015;53(2):681–3. https://doi.org/10.1128/jcm.03068-14
Adekanmbi AO, Akinlabi OC, Usidamen S, Olaposi AV, Olaniyan AB. High burden of ESBL-producing Klebsiella spp., Proteus mirabilis, Enterobacter cloacae and Pseudomonas aeruginosa in diagnosed cases of urinary tract infection in a Nigerian Teaching Hospital. Acta microbiologica et immunologica Hungarica. 2022;69(2):127–34. https://doi.org/10.1556/030.2022.01747
Rezai MS, Bagheri-Nesami M, Nikkhah A. Catheter-related urinary nosocomial infections in intensive care units: An epidemiologic study in North of Iran. Caspian journal of internal medicine. 2017;8(2):76. https://journals.asm.org/doi/10.1128/jcm.03068-14
Khaledi A, Elahifar O, Vazini H, Alikhani MY, Bahrami A, Esmaeili D, et al. Increasing trend of imipenem-resistance among acinetobacter baumannii isolated from Hospital Acquired Pneumonia in Northeast of Iran. 2017. https://ajcmi.umsha.ac.ir/Article/ajcmi-116
Osman KM, Kappell AD, ElHofy F, Orabi A, Mubarak AS, Dawoud TM, et al. Urinary tract infection attributed to Escherichia coli isolated from participants attending an unorganized gathering. Future microbiology. 2018;13(7):757–69. https://doi.org/10.2217/fmb-2017-0304
Kalal BS, Nagaraj S. Urinary tract infections: a retrospective, descriptive study of causative organisms and antimicrobial pattern of samples received for culture, from a tertiary care setting. Germs. 2016;6(4):132. https://pmc.ncbi.nlm.nih.gov/articles/PMC5187754/
Ciesielczuk H. Extra-intestinal pathogenic Escherichia coli in the UK. The importance in bacteraemia versus urinary tract infection, colonisation of widespread clones and specific virulence factors: Queen Mary University of London; 2015. http://qmro.qmul.ac.uk/xmlui/handle/123456789/8983
Uwizeyimana JD, Kim D, Lee H, Byun J-H, Yong D. Determination of colistin resistance by simple disk diffusion test using modified Mueller-Hinton agar. Ann Lab Med. 2020;40(4):306–11. https://pubmed.ncbi.nlm.nih.gov/32067429/
Rehman N, Azam S, Ali A, Asghar M, Ali M, Waqas M, et al. Molecular epidemiology of antibiotic-resistant genes and potent inhibitors against TEM, CTX-M-14, CTX-M-15, and SHV-1 proteins of Escherichia coli in district Peshawar, Pakistan. Saudi Journal of Biological Sciences. 2021;28(11):6568–81. https://doi.org/10.1016/j.sjbs.2021.07.028
Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. The Lancet infectious diseases. 2019;19(1):56–66.DOI;10.1016/S1473-3099(18)30605-4
Denning DW, Perlin DS, Muldoon EG, Colombo AL, Chakrabarti A, Richardson MD, et al. Delivering on antimicrobial resistance agenda not possible without improving fungal diagnostic capabilities. Emerging infectious diseases. 2017;23(2):177. https://pmc.ncbi.nlm.nih.gov/articles/PMC5324810/
Storme O, Tirán Saucedo J, Garcia-Mora A, Dehesa-Dávila M, Naber KG. Risk factors and predisposing conditions for urinary tract infection. Therapeutic advances in urology. 2019;11:1756287218814382. https://doi.org/10.1177/1756287218814382
Marotta F, Di Marcantonio L, Janowicz A, Pedonese F, Di Donato G, Ardelean A, et al. Genotyping and antibiotic resistance traits in Campylobacter jejuni and coli from pigs and wild boars in Italy. Frontiers in cellular and infection microbiology. 2020;10:592512. https://doi.org/10.3389/fcimb.2020.592512
Nasrollahian S, Graham JP, Halaji M. A review of the mechanisms that confer antibiotic resistance in pathotypes of E. coli. Frontiers in Cellular and Infection Microbiology. 2024;14:1387497. https://doi.org/10.3389/fcimb.2024.1387497
Mondol SM, Islam MR, Mia ME, Hassan MH, Farhad F, Akter K, et al. Molecular and genomic insights into multidrug-resistant (MDR) and extensively drug-resistant (XDR) Pseudomonas aeruginosa causing burn wound infections in Bangladesh. Scientific reports. 2025;15(1):25445. https://www.nature.com/articles/s41598-025-11614-6#citeas
Ghenea AE, Zlatian OM, Cristea OM, Ungureanu A, Mititelu RR, Balasoiu AT, et al. TEM, CTX-M, SHV genes in ESBL-producing Escherichia coli and Klebsiella pneumoniae isolated from clinical samples in a county clinical emergency hospital Romania-predominance of CTX-M-15. Antibiotics. 2022;11(4):503. https://doi.org/10.3390/antibiotics11040503
Liu Y-Y, Wang Y, Walsh TR, Yi L-X, Zhang R, Spencer J, et al. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. The Lancet infectious diseases. 2016;16(2):161-8. DOI: 10.1016/S1473-3099(15)00424-7
Yin W, Li H, Shen Y, Liu Z, Wang S, Shen Z, et al. Erratum for Yin et al.,“Novel Plasmid-Mediated Colistin Resistance Gene mcr-3 in Escherichia coli”. MBio. 2017;8(4):e01166–17. https://doi.org/10.1128/mbio.00543-17
Boerlin P, Travis R, Gyles CL, Reid-Smith R, Heather Lim NJ, Nicholson V, et al. Antimicrobial resistance and virulence genes of Escherichia coli isolates from swine in Ontario. Applied and environmental microbiology. 2005;71(11):6753–61. https://doi.org/10.1128/AEM.71.11.6753-6761.2005
This work is licensed under a 