Determinants of quinolone resistance in Escherichia coli causing community-acquired urinary tract infection in Bejaia,Algeria

Objective:To investigate the mechanisms of quinolone resistance and the association with other resistance markers among Esherichia coli(E.coli) strains isolated from outpatient with urinary tract infection in north of Algeria.Methods:A total of 30 nalidixic acid-resistant E.coli isolates from outpatient with urinary tract infections from January 2010 to April 2011 in north of Algeria(Bejaia) were studied.Antimicrobial susceptibility was determined by disc diffusion assay,minimal inhibitory concentrations(MIC) of quinolone were determined by microdilution.Mutations in the Quinolone Resistance-Determining Region(QRDR) of gyra and parC genes and screening for qnr(A,B and S) and bla genes were done by PCK and UNA sequencing.Results:Most of the E.coli isolates(56.66%) were shown to carry mutations in gyrA and parC,igyra:Ser83Leu + Asp87Asn and parC:Ser80Iler.While.16.66 had only an alteration in gyrA:Ser83Leu.One isolate produced qnrB-like and two qnrS-like.Four isolates were CTXM-15 producers associated with TEM-1 producing in one case.Co-expression of bla_(LTV,M)_(15) and qnrB was determined in one E.coli isolate.Conclusions:Our findings suggested the community emergence of gyrA and parC alterations and Qnr determinants that contributed to the development and spread of fluoroquinolone resistance in Algerian E.coli isolates.     

Recurrent reactive arthritis associated with urinary tract infection by Escherichia coli.

We describe a patient with recurrent Escherichia coli urinary tract infection followed by recurrent reactive arthritis. During a 9 year period the patient developed 4 episodes of arthritis. During each attack, triggering infections were thoroughly investigated but no other causative infection was found. Although the urinary tract is not routinely targeted for triggering infections for reactive arthritis, we suggest that urinary tract infections should be included in the diagnostic investigations of patients with acute arthritis.     

Occurrence of Escherichia coli in urinary tract infection]

Regarding P-fimbriae, K1 antigen, sero O-type and factors on the host (age, sex and morbidity) with are the pathogenic factors in E. coli, an assessment has been made as to what relations these factors have in urinary tract infection. By age, cases of P-fimbriae is seen in large numbers among pregnant women and infants but less among the people aged 16-30. A similar trend was observed regarding K1 antigen. An assessment made by sex show a trend that E. coli which carries P-fimbriae tends to emerge frequently in males. By morbidity, P-fimbriated strain was seen in many severe cases among pregnant women and infants. The fact has become evident further as a result of making an investigation with K1 antigen added. However, the result of an assessment made in adult cases showed that P-fimbriae was seen frequently in simple cystitis conversely. As the reason for P-fimbriae being observed more in males, participations of immunological stage and anatomical factors on the host side in the pathogenicity was resumed, and the main cause that P-fimbriae is seen more in severe pregnant and infantile cases was presumed to be vesicoureteral reflux. Regarding group sero O-type and morbidity, the types reported so far were detected also at our hospital, but a very interesting finding we have obtained was that the stains P-fimbriae and K1 antigen were observed in types 2, 12, 18 and 75.     

CTX-M-producing Escherichia coli and Klebsiella pneumoniae isolated from community-acquired urinary tract infections in Valledupar,Colombia

ObjectiveDescribe the presence of CTX-M-1 phylogenetic subgroup extended-spectrum β-lactamases (ESBL), associated with TEM and SHV genes, and the gene encoding cephalosporinase, CMY-2 in Escherichia coli and Klebsiella pneumoniae isolates from community-acquired urinary tract infections.Methods102 E. coli and 21 K. pneumoniae were collected from patients with culture-proven urinary tract infection (UTI), during February and March, 2011. Antimicrobial susceptibility test was performed by disk diffusion according to the standards of the Clinical Laboratory Standard Institute. Screening for cephalosporins-resistant E. coli and K. pneumoniae was performed by PCR assay for bla_TEM, bla_SHV, bla_CTX-M-1,_-2,_-8,_-9, bla_PER-2 and bla_CMY-2 genes. Statistical analysis was performed by chi-squared test and multivariate logistic regression analysis.ResultsESBL production was detected in 12 (11.7%) E. coli and four (19%) K. pneumoniae isolates. TEM ESBLs were detected in seven E. coli and three K. pneumoniae isolates. SHV ESBLs were found in four K. pneumoniae isolates. CTX-M-1 phylogenetic subgroup was positive in seven E. coli and three K. pneumoniae isolates. CMY-2 β-lactamase gene was detected in nine E. coli and one K. pneumoniae isolates. A signi?cant association of ESBL expression in E. coli was observed with resistance to tobramycin (p ≤ 0.001), tetracycline (p = 0.043), and ciprofloxacin (p ≤ 0.001). In K. pneumoniae isolates, significant association was found with resistance to tobramycin and ciprofloxacin (p = 0.006), and trimethoprim-sulfamethoxazole (p = 0.043). Multivariate analyses did not show association between ESBL production in E. coli and K. pneumoniae, and resistance to non-β-lactams drugs.ConclusionsCTX-M ESBL in uropathogens isolated from the community is cause for concern due to the enormous potential for multidrug resistance from strains that produce these enzymes, which could lead to failure of empirically-administered therapies and development of complicated UTIs.     

Two cases of human urinary tract infection complicated by hemolytic uremic syndrome caused by verotoxin-producing Escherichia coli.

In 1993, 2 cases of urinary tract infection (UTI) caused by verotoxin-producing Escherichia coli were diagnosed at Rigshospitalet in Copenhagen, Denmark. Neither of the patients had any previous history of diarrhea. We suggest that E. coli strains isolated from UTI be examined for the production of verotoxin when hemolytic uremic syndrome is clinically suspected.     

Factors affecting virulence in Escherichia coli urinary tract infections.

The prevalence of E. coli relative to other bacteria in the urinary tract is assumed to be the result of its proximity to and its close relationship with the gastrointestinal tract. Strains on E. coli may establish themselves more readily in the urinary tract, and/or invade the upper urinary tract, if they have a number of different virulence factors. The relative importance of these factors in the development of urinary tract infection, with or without renal involvement, is not clear. In addition, the means by which these factors may increase the virulence of E. coli are not understood, although there seems to be some evidence that the K antigens alter resistance to phagocytosis and serum bactericidal activity %9,10]. The main reason that certain E. coli serotypes are cultured from the urinary tract, however, still seems to be their dominance in the stool. The broader question of why certain O serotypes of E. coli dominate the bowel flora has not been examined adequately. The studies suggesting that the K antigen is a significant virulence factor seem to be in conflict with other studies indicating the dominance of certain serotypes of E. coli in the stool and in urinary tract infections. A resolution of this dilemma may possibly be found in the recent observations of Dr. Frits Orskov [20] and others discussed elsewhere at this meeting that the K and O serotypes appear to be interrelated.     

Isolation of verotoxin producing Escherichia coli from diarrhoeal and urinary tract infection patients

Fourty nine Escherichia coli strains, isolated from diarrhoeal and urinary tract infection (UTI) patients, attending Bareilly district hospital, Uttar Pradesh during October to December, 1998 were screened for verotoxin (VT) production by Vero cell assay. Five strains produced characteristic cytopathic effect on Vero cell line, of which 4 were from diarrhoeal and one was from UTI-patient. The level of VT-production varied widely. Antibiotic sensitivity tests revealed that the VT-producing E. coli (VTEC) were mostly sensitive to kanamycin, norfloxacin and nalidixic acid but resistant to ampicillin and tetracycline.     

Significance of fluoroquinolone-resistant Escherichia coli in urinary tract infections

Antibiotic-resistant urinary tract infections (UTIs) are on the rise. We investigated the recent emergence of representative resistant strains in patients diagnosed with UTIs at Kobe University Hospital between 2000 and 2006, focusing on resistant strains isolated from the urine of UTI patients, especially fluoroquinolone-resistant Escherichia coli (FQRE), multidrug-resistant Pseudomonas aeruginosa (MDRP), and methicillin-resistant Staphylococcus aureus (MRSA). We found 16 MDRP, 108 FQRE, and 251 MRSA UTI cases, reflecting a significant increase in the incidence of FQRE. Our data demonstrated that isolated ratios of FQRE rose as much as 26.3% in 2006 and that there were significantly more isolated cases in 2003 - 2006 than in 2000 - 2002. The data show a significant trend toward FQRE emergence. This trend should be considered when treating UTI.     

P菌毛粘附素在致肾盂肾炎大肠埃希菌对小鼠尿道上行感染中的作用

目的 比较2株具有不同P菌毛粘附素(PapG)的同血清型UPEC和1株无菌毛大肠埃希菌对小鼠泌尿道上行感染性的差异,探讨粘附素在UPEC尿道感染中的作用。方法 通过17PEC尿道内接种形成BALB/c小鼠尿道上行感染;观察尿液、肾脏剖面的菌落计数和肾组织的病理改变。结果 具有P菌毛的UPEC菌株感染之小鼠,在其尿液和肾剖面培养出大量原感染菌,肾组织呈现中、重度急性肾盂肾炎的病理改变;不同P菌毛粘附素的UPEC感染的菌落计数、肾脏病理改变严重度无显著性差异;无菌毛大肠埃希菌感染之小鼠,其尿液和肾剖面只有少量原感染茵生长,肾组织为轻至中度急性炎症改变。结论具有不同粘附素之P菌毛在介导UPEC致小鼠上行性急性肾盂肾炎中均发挥重要作用;无菌毛大肠埃希菌亦可导致小鼠肾脏炎性改变。     

Diarrheagenic enteroaggregative Escherichia coli causing urinary tract infection and bacteremia leading to sepsis

We report a case of a 55-year-old immunocompromised female who presented to the emergency department with severe diarrhea and vomiting following travel to the Philippines. Stool bacteriology revealed a mixed infection involving an enteropathogenic Escherichia coli and two distinct strains of enteroaggregative Escherichia coli (EAEC). During hospitalization, urine and blood culture tested positive for one of the diarrheagenic EAEC strains, necessitating urinary catheterization, intensive care, and antimicrobial treatment with trimethoprim–sulfamethoxazole, followed by meropenem. Although known to occasionally cause urinary tract infections, EAEC have not been previously associated with sepsis. Our report highlights the potential of EAEC to cause severe extraintestinal infections.     

A disseminated multidrug-resistant clonal group of uropathogenic Escherichia coli in pyelonephritis

In acute pyelonephritis, bacterial resistance to co-trimoxazole predicts treatment failure, but the clonal basis of such resistance is undefined. We did molecular and serological analyses of 170 Escherichia coli urine isolates obtained in 1994-96 from women with acute pyelonephritis. 12 (7%) of the pyelonephritis isolates were in clonal group A (CGA; responsible for 38-51% of co-trimoxazole resistance in acute cystitis), including ten (34%) of 29 isolates that were resistant to co-trimoxazole. CGA isolates were obtained from diverse locations across the USA and were related to the O15:K52:H1 clone of the 1986-87 outbreak in London, UK. Thus, CGA is broadly disseminated and contributes to co-trimoxazole resistance in pyelonephritis as well as in cystitis.     

pap genotype and P fimbrial expression in Escherichia coli causing bacteremic and nonbacteremic febrile urinary tract infection.

Escherichia coli strains from patients with febrile urinary tract infections (n=73) were examined for pap genotype and P fimbrial expression in relation to bacteremia and patients' background variables. Most isolates were pap(+) by DNA hybridization (n=51), and 36 were papG(IA2)(+) and 18 prsG(J96)(+) by polymerase chain reaction. The pap and papG genotypes of the infecting strain were shown to vary with host compromise, sex, and age. Bacteremia in noncompromised patients was caused by papG(IA2)(+) strains, but compromised hosts carried a mixture of papG(IA2)(+), prsG(J96)(+), and pap(-) strains. Women of all ages were infected with papG(IA2)(+) strains. Infected men carried prsG(J96)(+) or pap(-) strains and were older, and most had compromising conditions. papG(IA2)(+) strains predominated among patients with medical illness, whereas prsG(J96)(+) strains predominated among patients with urinary tract abnormalities. These findings emphasize the strong influence of host factors on the selection of E. coli strains causing febrile urinary tract infections.