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Treatment Failure in Urinary Tract Infections: A Warning Witness for Virulent Multi-Drug Resistant ESBL- Producing Escherichia coli.
Infect Drug Resist. 2020; 13:1839-1850.ID

Abstract

Background

Global increase in the prevalence of virulent extended-spectrum beta-lactamase (ESBL)-producing uropathogenic Escherichia coli (UPEC), which is also multi-drug resistant (MDR), leads to increase in severity of urinary tract infections (UTIs), decrease in the efficacy of the first-line antibiotics, and therefore increase in the morbidity and mortality rates.

Methods

We investigated the distribution of ESBL-producing UPEC in 78 E. coli isolates from community-acquired UTI patients in southern Iran. The prevalence of three major ESBL genes, antimicrobial resistance patterns against 15 conventional antibiotic disks, and the presence of 11 important virulence genes that involve in the development and progression of UTIs were evaluated in these isolates.

Results

Of the UPECs, 34.6% were ESBL-positive and 96.3% of the ESBL-producers were MDR. Among the ESBL-producers, 100% harbored blaCTX-M, 63% harbored blaSHV, and 11.1% harbored blaTEM genes. ESBL-producers showed a higher level of resistance to the tested cephalosporins, fluoroquinolones, trimethoprim-sulfamethoxazole, and tetracycline than non-ESBL producers. All isolates were resistant to the tested penicillins. Prevalence of resistance to about two-third of the tested antibiotics was higher than 50% and 93.6% of the isolates were MDR. High prevalence of virulence factors particularly the adhesins (82.1% csgA, 73.1% fimH genes) and siderophore (73.1% sitA gene) was seen in the UPECs. But fortunately in MDR isolates, the virulence score and prevalence of hemagglutinin (tsh), hemolysin toxin (hlyD) and invasin (ibeA) genes were lower than in non-MDR UPECs. Shockingly, among the 15 common antibiotics, only nitrofurantoin (<20% resistance) could be recommended as an appropriate drug for the treatment of UTIs due to our ESBL-producer UPECs.

Conclusion

The alarming level of virulent MDR ESBL-producer E. coli strains in this study necessitates the performing of an antibiotic stewardship program, regional screening of ESBL-producers and their virulence properties to select appropriate antibiotic, or designing new therapeutic methods for UTIs by inactivation of the essential virulence factors of UPECs.

Authors+Show Affiliations

Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32606833

Citation

Naziri, Zahra, et al. "Treatment Failure in Urinary Tract Infections: a Warning Witness for Virulent Multi-Drug Resistant ESBL- Producing Escherichia Coli." Infection and Drug Resistance, vol. 13, 2020, pp. 1839-1850.
Naziri Z, Derakhshandeh A, Soltani Borchaloee A, et al. Treatment Failure in Urinary Tract Infections: A Warning Witness for Virulent Multi-Drug Resistant ESBL- Producing Escherichia coli. Infect Drug Resist. 2020;13:1839-1850.
Naziri, Z., Derakhshandeh, A., Soltani Borchaloee, A., Poormaleknia, M., & Azimzadeh, N. (2020). Treatment Failure in Urinary Tract Infections: A Warning Witness for Virulent Multi-Drug Resistant ESBL- Producing Escherichia coli. Infection and Drug Resistance, 13, 1839-1850. https://doi.org/10.2147/IDR.S256131
Naziri Z, et al. Treatment Failure in Urinary Tract Infections: a Warning Witness for Virulent Multi-Drug Resistant ESBL- Producing Escherichia Coli. Infect Drug Resist. 2020;13:1839-1850. PubMed PMID: 32606833.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment Failure in Urinary Tract Infections: A Warning Witness for Virulent Multi-Drug Resistant ESBL- Producing Escherichia coli. AU - Naziri,Zahra, AU - Derakhshandeh,Abdollah, AU - Soltani Borchaloee,Arash, AU - Poormaleknia,Meisam, AU - Azimzadeh,Negar, Y1 - 2020/06/17/ PY - 2020/04/02/received PY - 2020/06/01/accepted PY - 2020/7/2/entrez PY - 2020/7/2/pubmed PY - 2020/7/2/medline KW - extended spectrum beta-lactamases KW - multi-drug resistance KW - urinary tract infection KW - uropathogenic Escherichia coli KW - virulence factor SP - 1839 EP - 1850 JF - Infection and drug resistance JO - Infect Drug Resist VL - 13 N2 - Background: Global increase in the prevalence of virulent extended-spectrum beta-lactamase (ESBL)-producing uropathogenic Escherichia coli (UPEC), which is also multi-drug resistant (MDR), leads to increase in severity of urinary tract infections (UTIs), decrease in the efficacy of the first-line antibiotics, and therefore increase in the morbidity and mortality rates. Methods: We investigated the distribution of ESBL-producing UPEC in 78 E. coli isolates from community-acquired UTI patients in southern Iran. The prevalence of three major ESBL genes, antimicrobial resistance patterns against 15 conventional antibiotic disks, and the presence of 11 important virulence genes that involve in the development and progression of UTIs were evaluated in these isolates. Results: Of the UPECs, 34.6% were ESBL-positive and 96.3% of the ESBL-producers were MDR. Among the ESBL-producers, 100% harbored blaCTX-M, 63% harbored blaSHV, and 11.1% harbored blaTEM genes. ESBL-producers showed a higher level of resistance to the tested cephalosporins, fluoroquinolones, trimethoprim-sulfamethoxazole, and tetracycline than non-ESBL producers. All isolates were resistant to the tested penicillins. Prevalence of resistance to about two-third of the tested antibiotics was higher than 50% and 93.6% of the isolates were MDR. High prevalence of virulence factors particularly the adhesins (82.1% csgA, 73.1% fimH genes) and siderophore (73.1% sitA gene) was seen in the UPECs. But fortunately in MDR isolates, the virulence score and prevalence of hemagglutinin (tsh), hemolysin toxin (hlyD) and invasin (ibeA) genes were lower than in non-MDR UPECs. Shockingly, among the 15 common antibiotics, only nitrofurantoin (<20% resistance) could be recommended as an appropriate drug for the treatment of UTIs due to our ESBL-producer UPECs. Conclusion: The alarming level of virulent MDR ESBL-producer E. coli strains in this study necessitates the performing of an antibiotic stewardship program, regional screening of ESBL-producers and their virulence properties to select appropriate antibiotic, or designing new therapeutic methods for UTIs by inactivation of the essential virulence factors of UPECs. SN - 1178-6973 UR - https://www.unboundmedicine.com/medline/citation/32606833/Treatment_Failure_in_Urinary_Tract_Infections:_A_Warning_Witness_for_Virulent_Multi-Drug_Resistant_ESBL-_Producing_Escherichia_coli L2 - https://dx.doi.org/10.2147/IDR.S256131 DB - PRIME DP - Unbound Medicine ER -
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