Virulence Genotyping and Multidrug Resistance Pattern of Escherichia coli Isolated From Community-Acquired and Hospital-Acquired Urinary Tract Infections.

Introduction Uropathogenic Escherichia coli(UPEC) strains consist of a plethora of putative virulence factors (VFs), which help them to establish infection in the urinary tract. We compared genotypic profiles of Escherichia coli (E. coli) strains associated with community-acquired (CA) urinary tract infection (UTI; n=100) and hospital-acquired (HA) UTI (n=50) in the present study in order to identify specific virulence determinants, if any, associated with either form of UTI and its association with antibiotic resistance pattern of the isolates. Materials and methods E. coli strains were analyzed for antimicrobial susceptibility patterns, phylogroups, and 10 putative virulence-associated genes. The bacterial culture and identification were done using standard conventional methods. Tests for antimicrobial susceptibility and phenotypic detection for extende- spectrum beta-lactamases (ESBL) were done by using the Kirby Bauer disc diffusion method, and results were interpreted as per Clinical & Laboratory Standards Institute (CLSI) guidelines. The phylotype (A, B1, B2, and D) of each E. coli isolate was determined by a triplex polymerase chain reaction (PCR) based phylotyping method. They were further analyzed for the presence of 10 putative virulence genes (VGs), including adhesins papA (P fimbrial structural subunit), papG alleles I, II (P fimbrial adhesin variants), fimH (type 1 fimbriae), toxins hlyA (hemolysin) siderophores chuA (heme-binding protein); yfcV (encodes a major subunit of a putative chaperone-usher fimbria) capsule synthesis specific for group II (K1, K5, K12, etc.) kpsMII; serum resistance-associated traT, and upaH by multiplex PCR. Results HA E. coli isolates were significantly more drug-resistant than CA isolates; carbapenem (80% vs. 16%), ceftazidime (92% vs. 63%). The majority (52%) of E.coli isolates associated with HA UTI belong to commensal phylogroup A and B1, whereas the majority (66%) in CA were from pathotypic phylogroups, i.e., B2 & D. Most of VFs were frequently present amongst CA group except for traT and yfc, kpsMTII, hlyA, chuA, and upaH were significantly associated with CA E.coli isolates while yfc was significantly present in HA E.coli isolates. Though adhesin genes such as papA, papGI, papGII, fimH were frequently found in the CA group, they were not significantly associated. The average virulence score was higher for CA UTI isolates (4.25) than for the HA strains (3.9). Multidrug resistance (MDR) was present in every HA E.coli isolate, and fimH, traT, and yfc genes showed significant association with MDR strains. Conclusion On detailed analysis, we found that HA E. coli isolates had a high frequency of MDR and comparatively reduced VFs content. Thus, it can be assumed that a strain with lesser virulence is able to cause HA UTIs, as compared to CA UTIs, which probably indicates that the host's immune status/general condition can be an important determinant in acquiring infection rather than virulence potential of the pathogen alone.