Enteroaggregative Escherichia coli is associated with antibiotic resistance and urinary tract infection symptomatology

Verónica I Martínez-Santos; María Ruíz-Rosas; Arturo Ramirez-Peralta; Oscar Zaragoza García; Luis Armando Resendiz-Reyes; Obed Josimar Romero-Pineda; Natividad Castro-Alarcón

doi:10.7717/peerj.11726

Enteroaggregative Escherichia coli is associated with antibiotic resistance and urinary tract infection symptomatology

PeerJ. 2021 Aug 24:9:e11726. doi: 10.7717/peerj.11726. eCollection 2021.

Authors

Verónica I Martínez-Santos¹, María Ruíz-Rosas², Arturo Ramirez-Peralta³, Oscar Zaragoza García⁴, Luis Armando Resendiz-Reyes⁴, Obed Josimar Romero-Pineda⁴, Natividad Castro-Alarcón⁴

Affiliations

¹ Cátedras CONACyT, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México.
² Laboratorio Clínico, Área Microbiología, Clínica Hospital ISSSTE Chilpancingo, Chilpancingo, Guerrero, México.
³ Laboratorio de Patometabolismo Microbiano, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México.
⁴ Laboratorio de Investigación en Microbiología, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México.

Abstract

Background: Uropathogenic Escherichia coli (UPEC) is the causative agent of uncomplicated urinary tract infections (UTIs) in ambulatory patients. However, enteroaggregative E. coli (EAEC), an emergent bacterial pathogen that causes persistent diarrhoea, has recently been associated with UTIs. The aim of this study was to determine the frequency of EAEC virulence genes, antibiotic resistance, as well as biofilm production of UPEC isolates obtained from ambulatory patients with non-complicated UTIs that attended to the ISSSTE clinic in Chilpancingo, Guerrero, Mexico, and correlate these with the patients' urinary tract infection symptomatology.

Methods: One hundred clinical isolates were obtained. The identification of clinical isolates, antimicrobial susceptibility testing, and extended spectrum beta-lactamases (ESBLs) production were performed using the Vitek automated system. Assignment of E. coli phylogenetic groups was performed using the quadruplex phylo-group assignment PCR assay. UPEC virulence genes (hlyA, fimH, papC, iutA, and cnf1) and EAEC virulence genes (aap, aggR, and aatA) were detected by multiple PCR.

Results: We found that 22% of the isolates carried the aggR gene and were classified as UPEC/EAEC. The main phylogenetic group was B2 (44.1% were UPEC and 77.27% UPEC/EAEC isolates, respectively). Over half of the UPEC/EAEC isolates (63.64%) were obtained from symptomatic patients, however the aatA gene was the only one found to be associated with the risk of developing pyelonephritis (OR = 5.15, p = 0.038). A total of 77.71% of the UPEC/EAEC isolates were ESBL producers and 90.91% multidrug-resistant (MDR). In conclusion, UPEC/EAEC isolates are more frequent in symptomatic patients and the aatA gene was associated with a higher risk of developing pyelonephritis, along with UPEC genes hlyA and cfn1. UPEC/EAEC isolates obtained from UTI showed ESBL production and MDR.

Keywords: Antibiotic resistance; Biofilm; Enteroagregative; Escherichia coli; Extended spectrum beta lactamases; Infection symtomatology; Multidrug resistant; Phylogenetic groups; Uropathogenic; Virulence factor.

Grants and funding

This work was supported by the Fondo FOMIX-CONACYT Gobierno del Estado de Guerrero, Convocatoria M0008 2014-01 (No. 249671). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.