Outcome of acute urinary tract infections caused by uropathogenic Escherichia coli with phenotypically demonstrable virulence factors.

Background: Urinary tract infection (UTI) caused by uropathogenic Escherichia coli (UPEC) strains is one of the most important community-acquired infections in the world. The presence of virulence factors is closely related with the pathogenesis of UTI. Methods: The present study was conducted on 150 isolates of UPEC obtained from symptomatic and asymptomatic cases of UTIs with significant counts (≥105 CFU/ml) during 1 year. UPEC isolates were studied for hemolysis on 5% sheep blood agar, mannose-sensitive hemagglutination (MSHA), mannose-resistant hemagglutination (MRHA), and biofilm formation by recommended methods. Patients with UTI due to UPEC showing virulence factors were evaluated for the treatment received and the outcome of treatment. These were compared with the outcomes of patients whose culture samples grew UPEC without demonstrable virulence factors. Results: The study showed hemolysin production in 40% of the isolates. Forty percent of the isolates showed the presence of P fimbriae (MRHA) and 60% showed Type 1 fimbriae (MSHA). Biofilm formation capacity of all UPEC isolates was classified into three categories, strong biofilm producers (4%), moderate biofilm producers (88%), and nonbiofilm producers (8%). Patients harboring all three virulence factors showed 76% recovery compared to patients harboring strains with no demonstrable virulence factors, who showed 100% recovery. Conclusion: The present study has shown the production of various virulent factors and developing drug resistance in UPEC. Treatment outcomes of patients harboring strains with no virulence factors seem to be better than the ones which contain multiple virulence factors. UPEC occurs because of multiple virulence factors. Biofilm formation and MRHA are more likely to be seen in catheterized patients. The drug resistance among UPEC is on rise; therefore, the selection of appropriate antibiotics (after antibiotic susceptibility testing) is must for proper treatment of patients and to avoid emergence of drug resistance. Significant number of the UPEC isolates was sensitive to nitrofurantoin, and half of the isolates were sensitive to cotrimoxazole, so treatment is by giving these drugs orally.

RésuméFond: L'infection urinaire (UTI) provoquée par des tensions uropathogenic d'Escherichia coli (UPEC) est l'une des infections acquises par - le plus important de la communauté dans le monde. La présence des facteurs de virulence est étroitement liée avec la pathogénie d'UTI. Méthodes: La présente étude a été conduite sur 150 isolats d'UPEC obtenu à partir des cas symptomatiques et asymptomatiques d'UTIs avec les comptes significatifs (≥105CFU/ml) pendant 1 an. Des isolats d'UPEC ont été étudiés pour le hemolysis sur l'agar de sang de moutons de 5%, l'hémagglutination sensible de - de mannose (MSHA), l'hémagglutination résistante de - de mannose (MRHA), et la formation de biofilm par des méthodes recommandées. Des patients avec UTI dû à UPEC montrant des facteurs de virulence ont été évalués pour le traitement reçu et les résultats du traitement. Ceux-ci ont été comparés aux résultats des patients dont les échantillons de culture ont élevé UPEC sans facteurs démontrables de virulence. Résultats: L'étude a montré la production d'hémolysine dans 40% des isolats. Quarante pour cent des isolats ont montré que la présence des fimbriae de P (MRHA) et de 60% a montré les fimbriae de type 1 (MSHA). La capacité de formation de Biofilm de tous les isolats d'UPEC a été classifiée dans trois catégories, producteurs forts de biofilm (4%), producteurs modérés de biofilm (88%), et producteurs de nonbiofilm (8%). Les patients hébergeant chacun des trois facteurs de virulence ont montré la récupération de 76% comparée aux patients hébergeant des tensions sans les facteurs démontrables de virulence, qui ont montré la récupération 100%. Conclusion: La présente étude a montré la production de divers facteurs virulents et de résistance au médicament se développante dans UPEC. Les résultats de traitement des patients hébergeant des tensions sans des facteurs de virulence semblent être meilleurs que ceux qui contiennent des facteurs multiples de virulence. UPEC se produit en raison des facteurs multiples de virulence. La formation de Biofilm et les MRHA sont pour être vus dans les patients cathétérisés. La résistance au médicament parmi UPEC est sur la hausse ; donc, la sélection des antibiotiques appropriés (après qu'essai antibiotique de susceptibilité) est nécessité pour le traitement approprié des patients et pour éviter l'émergence de la résistance au médicament. Le nombre significatif des isolats d'UPEC était sensible au nitrofurantoin, et la moitié des isolats étaient sensible au cotrimoxazole, ainsi le traitement est en donnant ces drogues oralement.

Outcome of acute urinary tract infections caused by uropathogenic Escherichia coli with phenotypically demonstrable virulence factors

Background: Urinary tract infection (UTI) caused by uropathogenic Escherichia coli (UPEC) strains is one of the most important community-acquired infections in the world. The presence of virulence factors is closely related with the pathogenesis of UTI. Methods: The present study was conducted on 150 isolates of UPEC obtained from symptomatic and asymptomatic cases of UTIs with significant counts (≥105 CFU/ml) during 1 year. UPEC isolates were studied for hemolysis on 5% sheep blood agar, mannose-sensitive hemagglutination (MSHA), mannose-resistant hemagglutination (MRHA), and biofilm formation by recommended methods. Patients with UTI due to UPEC showing virulence factors were evaluated for the treatment received and the outcome of treatment. These were compared with the outcomes of patients whose culture samples grew UPEC without demonstrable virulence factors. Results: The study showed hemolysin production in 40% of the isolates. Forty percent of the isolates showed the presence of P fimbriae (MRHA) and 60% showed Type 1 fimbriae (MSHA). Biofilm formation capacity of all UPEC isolates was classified into three categories, strong biofilm producers (4%), moderate biofilm producers (88%), and nonbiofilm producers (8%). Patients harboring all three virulence factors showed 76% recovery compared to patients harboring strains with no demonstrable virulence factors, who showed 100% recovery. Conclusion: The present study has shown the production of various virulent factors and developing drug resistance in UPEC. Treatment outcomes of patients harboring strains with no virulence factors seem to be better than the ones which contain multiple virulence factors. UPEC occurs because of multiple virulence factors. Biofilm formation and MRHA are more likely to be seen in catheterized patients. The drug resistance among UPEC is on rise; therefore, the selection of appropriate antibiotics (after antibiotic susceptibility testing) is must for proper treatment of patients and to avoid emergence of drug resistance. Significant number of the UPEC isolates was sensitive to nitrofurantoin, and half of the isolates were sensitive to cotrimoxazole, so treatment is by giving these drugs orally