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High prevalence of plasmid-mediated quinolone resistance in escherichia coli strains producing extended-spectrum beta-lactamases isolated from faeces and urine of pregnant women with acute cystitis

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Abstract

Background

Escherichia coli is the most common etiological agent of urinary tract infections (UTIs). Meanwhile, plasmid-mediated quinolone resistance (PMQR) is reported in E. coli isolates producing extended-spectrum β-lactamases (ESBLs). Furthermore, the reservoirs and mechanisms of acquisition of uropathogenic Escherichia coli (UPEC) strains are poorly understood. On the other hand, UTIs are common in pregnant women and the treatment challenge is alarming.

Methods and results

In the present study, 54 pregnant women with acute cystitis were included. A total of 108 E. coli isolates, 54 isolates from UTI and 54 isolates from faeces of pregnant women (same host) were collected. In the antimicrobial susceptibility test, the highest rate of antibiotic resistance was to nalidixic acid (77%, 83/108) and the lowest rate was to imipenem (9%, 10/108). Among the isolates, 44% (48/108) were ESBLs producers. A high frequency of PMQR genes was observed in the isolates. The frequency of PMQR genes qnrS, qnrB, aac(6′)-Ib-cr, and qnrA was 58% (63/108), 21% (23/108), 9% (10/108), and 4% (4/108), respectively. Meanwhile, PMQR genes were not detected in 24% (20/85) of isolates resistant to nalidixic acid and/or fluoroquinolone, indicating that other mechanisms, i.e. chromosomal mutations, are involved in resistance to quinolones, which were not detected in the present study. In ESBL-producing isolates, the frequency of PMQR genes was higher than that of non-ESBL-producing isolates (81% vs. 53%). Meanwhile, UTI and faeces isolates mainly belonged to phylogenetic group B2 (36/54, 67% and 25/54, 46%, respectively) compared to other phylogenetic groups. In addition, virulence factors and multidrug-resistant (MDR) were mainly associated with phylogenetic group B2. However, predominant clones in faeces were not found in UTIs. Rep-PCR revealed the presence of 85 clones in patients. Among the clones, 40 clones were detected only in faeces (faeces-only), 35 clones only in UTI (UTI-only) and 10 clones in both faeces and UTI (faeces-UTI). We found that out of 10 faeces-UTI clones, 5 clones were present in the host’s faeces flora.

Conclusion

This study revealed a high rate of resistance to the quinolone nalidixic acid and a widespread distribution of PMQR genes in MDR E. coli strains producing ESBLs. The strains represented virulence factors and phylogenetic group B2 are closely associated with abundance in UTI and faeces. However, the predominant clones in faeces were not found in UTIs and it is possible that rep-PCR is not sufficiently discriminating clones.

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Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

The authors would like to thank the Research and Technology Vice-Chancellor of Shiraz University of Medical Sciences (No. IR.SUMS.REC. 1398.959) for financial support.

Funding

This research was supported by the Research and Technology Vice-Chancellor of Shiraz University of Medical Sciences (No. IR.SUMS.REC. 1398.959).

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Author notes

  1. Maryam Sohrabi and Javad Fathi contributed equally to this work.

Authors and Affiliations

  1. Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

    Maryam Sohrabi, Javad Fathi, Samane Mohebi, Zahra Hashemizadeh, Soudeh Kholdi, Mahtab Hadadi, Kowsar Keshavarz & Zahra Darvishvand

  2. Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Zahra Hashemizadeh

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Contributions

MS and Jf wrote the manuscript. SM, Jf and ZH designed the study. SKH and MH collected the samples. ZH performed the phenotypic and genotypic tests. MS, ZH, SM and ZD analyzed the data. ZH supervised the project and wrote and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Zahra Hashemizadeh.

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Ethics approval and consent to participate

This study was approved by the Ethics Committee of Shiraz University of Medical Sciences (No. IR.SUMS.REC. 1398.959). Written informed consent was obtained from each participant.

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Sohrabi, M., Fathi, J., Mohebi, S. et al. High prevalence of plasmid-mediated quinolone resistance in escherichia coli strains producing extended-spectrum beta-lactamases isolated from faeces and urine of pregnant women with acute cystitis. Mol Biol Rep 51, 566 (2024). https://doi.org/10.1007/s11033-024-09491-9

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