Pediatrik ve Yetişkin Hastalardan İzole Edilen E. coli İzolatlarının Antimikrobiyal Duyarlılıklarının ve Virülans Faktörlerinin İrdelenmesi

Öz

Bu çalışmada komplike olmayan idrar yolu enfeksiyonu tanısı almış pediatrik ve yetişkin hastalardan izole edilen E. coli izolatlarında antimikrobiyal direnç paternlerini ve virülans genlerinin prevalansını saptamayı hedefledik. Akut komplike olmayan idrar yolu enfeksiyonu tanısı almış toplam 83 pediatrik ve yetişkin ayaktan hastanın orta akım idrarından izole edilmiş kökenlerin, VITEK® 2 (bioMerieux, Marcy l’Etoile, France)  otomatize sistemi ile identifikasyonları ve antimikrobiyal direnç paternleri belirlendi. Bakterilerin direnç durumları dışında virülans genlerinin (pap, aer, sfa, hly ve cnf-1) prevalansı araştırıldı. Antimikrobiyal duyarlılık testleri sonucunda; sıklıkla idrar yolu enfeksiyonları için ampirik tedavide kullanılan siprofloksasin, trimetoprim-sülfametoksazol, gentamisin, ampisilin ve sefolatinin saptanan E. coli izolatlaında araştırılan diğer ajanlardan daha az duyarlı olduğu saptandı. Her iki yaş grubunda da en yüksek oranda saptnan virülans genler pap ve aer olarak bulundu. Pediatrik yaş grubunda en az oranda saptanan genler; sfa ve hly iken yetişkin yaş grubunda en az oranda saptanan gen hly olarak saptandı. Üropatojenik E. coli izolatlarında virülans faktörleri ile antimikrobiyal direnç paternleri arasında bir ikişki olduğunu gösteren yayın sayısı literatürde yok denecek kadar azdır. Antimikrobiyallere direnç ile virülans faktörlerinin ilişkisinin değerlendirilebilmesi için daha büyük çalışma grupları gerekmektedir.

Anahtar Kelimeler

• E.coli,Virülans,PCR,Antimikrobiyal Duyarlılık

Evaluation of Antimicrobial Resistance and Virulence Genes in Uropathogenic Escherichia coli in Pediatric and Adult Patients

Abstract

We aimed to evaluate the antimicrobial resistance patterns and the prevalence of certain virulence genes in uropathogenic E. coli isolated from pediatric and adult patients with uncomplicated urinary tract infection.We examined nonduplicate 83 uropathogenic E. coli isolated from mid-stream clean-catch urine samples of the pediatric and adult outpatients with the diagnosis of acute uncomplicated urinary tract infection. VITEK® 2 automated system (bioMerieux, Marcy l’Etoile, France) was used for identification and determination of antimicrobial resistance. We examined the isolates in respect to their antimicrobial resistance patterns and the presence of virulence genes (pap, aer, sfa, hly and cnf-1). Antimicrobial susceptibility testing results of the E. coli isolates revealed that commonly used empiric antimicrobials (ciprofloxacin, trimethoprim–sulfamethoxazole, gentamicin, ampicillin and cephalothin) for urinary tract infections were less effective than others. Most frequently detected virulence genes were pap and aer in both age groups. Sfa and hly genes were the least frequently detected genes in the pediatric age group; hly gene was the also the least common in the adult age group. There was no association with virulence factors and antimicrobial resistance patterns of the uropathogenic E. coli isolates in contrary to literature. More comprehensive studies with larger sample groups are needed to demonstrate the relation between virulence factors with antimicrobial drugs in different age groups. 

Keywords

• E. coli,Virulence,Antimicrobial Resistance,PCR

Kaynakça

1. Yun KW, Kim HK, Park HK, Kim W, Lim IS. Virulence factors of uropathogenic Escherichia coli of urinary tract infections and asymptomatic bacteriuria in children. J Microbiol Immunol Infect. 2014; 47(6): 455-61.
2. Santo E, Salvador MM, Marin JM. Multidrug-resistant urinary tract isolates of Escherichia coli from Ribeirao Preto, Sao Paulo, Brazil. Braz J Infect Dis. 2007; 11(6): 575–8.
3. Hassan SA, Jamal SA, Kamal M. Occurrence of multidrug resistant and ESBL producing E. coli causing urinary tract infections. J of Basic and Applied Sci. 2011; 7(1): 39–43.
4. Agarwal J, Srivastava S, Singh M. Pathogenomics of uropathogenic Escherichia coli. Indian J Med Microbiol. 2012; 30(2): 141–9.
5. Johnson JR, Porter SB, Zhanel G, Kuskowski MA, Denamurd E. Virulence of Escherichia coli clinical isolates in a murine sepsis model in relation to sequence type ST131 status, fluoroquinolone resistance, and virulence genotype. Infect Immun. 2012; 80(4): 1554-62.
6. Agarwal J, Mishra B, Srivastava S, Srivastava R. Genotypic characteristics and biofilm formation among Escherichia coli isolates from Indian women with acute cystitis. Royal Society of Tropical Medicine and Hygiene 2013; 107(3): 165-9.
7. Anvarinejad M, Farshad S, Ranjbar R, et al. Genotypic analysis of E. coli strains isolated from patients with cystitis and pyelonephritis. Iranian Red Crescent Medical Journal 2012; 14(7): 408-16.
8. Chiou YY, Chen MJ, Chiu NT, Lin CY, Tseng CC. Bacterial virulence factors are associated with occurrence of acute pyelonephritis but not renal scarring. J Urol 2010; 184: 2098-102.

9. Cusumano CK, Hung CS, Chen SL, Hultgren SJ. Virulence plasmid harbored by uropathogenic Escherichia coli functions in acute stages of pathogenesis. Infect Immun 2010; 78: 1457-67.
10. Crepin S, Houle S, Charbonneau ME, et al. Decreased expression of type 1 fimbriae by a pst mutant of uropathogenic Escherichia coli reduces urinary tract infection. Infect Immun 2012; 80: 2802-15.
11. Yamamoto S. Molecular epidemiology of Escherichia coli. J Infect Chemother 2007; 13; 68-73.
12. Bean DC, Krahe D, Wareham DW. Antimicrobial resistance in community and nosocomial Escherichia coli urinary tract isolates, London 2005 – 2006, Ann Clin Microbiol Antimicrob. 2008; 7: 13.
13. Yamamoto S, Terai A, Yuri K, Kurazono H, Takeda Y, Yoshida O. Detection of urovirulence factors in Escherichia coli by multiplex polymerase chain reaction. FEMS Immunol Med Microbiol. 1995; 12(2): 85-90.
14. Clinical and Laboratory Standards Institute (Formerly NCCLS) (2011). Performance Standards for Antimicrobial Susceptibility Testing; Twenty-First Informational Supplement CLSI document M100-S21, Clinical and Laboratory Standards Institute, Wayne, Pa.
15. Rahdar M, Rashki A, Miri HR, Ghalehnoo MR. Detection of pap, sfa, afa, foc, and fim adhesin-encoding operons in uropathogenic Escherichia coli isolates collected from patients with urinary tract infection. Jundishapur Journal of Microbiology. 2015; 8: e22647.
16. Adib N, Ghanbarpour R, Slotzadeh H, Alizade H. Antibiotic resistance profile and virulence genes of uropathogenic Escherichia coli isolates in relation to phylogeny. Trop Biomed 31.1 (2014): 17-25.
17. Zgur-Bertok D, Modric E, Grabnar M. Aerobactin uptake system, Col V production, and drug resistance encoded by a plasmid from an urinary tract infection Escherichia coli strain of human origin. Can J Microbiol 1990; 36: 297-9.
18. Svanborg C, Godaly G. Bacterial virulence in urinary tract infection. Infect Dis Clin North Am, 1997; 11(3): 513-29.
19. Garcia TA, Ventura CL, Smith MA, Merrell DS, O’Brien AD. Cytotoxic necrotizing factor 1 and hemolysin from uropathogenic Escherichia coli elicit different host responses in the murine bladder. Infect Immun 2013; 81: 99-109.
20. Bogyiova E, Kmetova M, Biros E, Siegfried L. Detection of pap-sfa- and afa-specific DNA sequences in Escherichia coli strains isolated from extraintestinal material. Folia Microbiol (Praha). 2002; 47(6): 723–6.
21. Saidenberg AB, Robaldo Guedes NM, Fernandes Seixas GH, et al. A survey for Escherichia coli virulence factors in asymptomatic free-ranging parrots. ISRN Vet Sci. 2012; 2012: 984813.
22. Mohajeri P, Khademi H, Ebrahimi R, Farahani A, Rezaei M. Frequency distribution of virulence factors in uropathogenic Escherichia coli isolated from Kermanshah in 2011-2012. Int J Appl Basic Med Res. 2014; 4(2): 111–6.
23. Tarchouna M, Ferjani A, Ben-Selma W, Boukadida J. Distribution of uropathogenic virulence genes in Escherichia coli isolated from patients with urinary tract infection. Int J Infect Dis. 2013; 17(6): 450-3.
24. Farshad S, Emamghorashi F. The prevalence of virulence genes of E. coli strains isolated from children with urinary tract infection. Saudi J Kidney Dis Transpl. 2009; 20(4): 613–7.
25. Asadi S, Kargar M, Solhjoo K, Najafi A, Ghorbani-Dalini S. The association of virulence determinants of uropathogenic Escherichia coli with antibiotic resistance. Jundishapur Journal of Microbiology. 2014; 7: e9936.
26. Horcajada JP, Soto S, Gajewski A, et al. Quinolone-resistant uropathogenic Escherichia coli strains from phylogenetic group B2 have fewer virulence factors than their susceptible counterparts. J Clin Microbiol. 2005; 43(6): 2962–4.
27. Arisoy M, Rad AY, Akin A, Akar N. Relationship between susceptibility to antimicrobials and virulence factors in pediatric Escherichia coli isolates. Int J Antimicrob Agents. 2008; 31(1): 4–8.
28. Zhao L, Chen X, Zhu X, et al. Prevalence of virulence factors and antimicrobial resistance of uropathogenic Escherichia coli in Jiangsu province (China). Urology. 2009; 74(3): 702–7.