March 2021 Vol.9 No.1

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Original Research Article

Association between virulence factors and antibiotic resistance in E.coli isolated from urinary tract infection patients in Banha University Hospitals, Egypt

Enas Sh. Khater^1* and Hammouda W. Sherif²

¹Microbiology and Immunology Department, Faculty of Medicine, Benha University, Egypt
²Urology Department, Faculty of Medicine, BenhaUniversity,Egypt

*Corresponding Author's Email: drenaskhater@yahoo.com

Received: 28 February 2021    I    Accepted: 26 March 2021    I    Published: 29 March 2021    I    Article ID: MRJMBS21012
Copyright © 2021 Author(s) retain the copyright of this article.
This article is published under the terms of the Creative Commons Attribution License 4.0.

Abstract

This study aimed to assess the antibiotic resistance pattern among E. coli isolated from patients with UTI, to detect the presence of virulence factors and biofilm formation and to evaluate the relation between virulence factors and antibiotic resistance. A cross sectional study was performed in Banha University Hospitals, Egypt from May to November, 2020. Urine samples were obtained from included patients. Vitek-2 was used for identification of isolates and performing antimicrobial susceptibility testing. Congo red agar method was used to detect biofilm formation. Isolated Escherichia coli strains were screened for harboring virulence genes; Pap C, Fim H, Sfa, Afa, Hly A, and Cnf1 using multiplex PCR. E.coli isolates showed highest resistance against ampicillin 86(96.6%) followed cefazolin 85(95.5%), while the most susceptibility was to both imipenem and meropenem 85(95.6%). Sixty two (67.7%) isolates were multidrug-resistant. Biofilm formation was detected in 54(60.7%) isolates. FimH has the highest prevalence 63(70.8%) among E. coli isolates, followed by Pap C 37(41.6%) and the least was Cnf 1 genes 2(2.2%). The prevalence of the FimH gene was markedly higher in the strains resistant to ampicillin, cefazolin, ceftazidime and ceftriaxone in comparison to the susceptible strains. The Pap C gene was related to resistance to ceftazidime, amoxicillin/clavulanic acid and Piperacillin/ Tazobactam. The Cnf1 gene was related to resistance to amoxicillin/ clavulanic acid and nitrofurantoin. There was a statistically significant difference between biofilm production and resistance to ampicillin, ceftriaxone, ceftazidime and ciprofloxacin. In conclusion multi drug resistant E. coli showed high prevelance among isolates 62(67.7%) which is a significant clinical challenge. The highest prevalence of virulence genes among the E coli strains such as FimH and PapC, suggesting their importance in pathogenesis of UTI caused by E coli. Relation between the virulence factors and antimicrobial resistance should be periodically evaluated in each health care facilities.

Keywords: Biofilm, Escherichia coli, UTI, Virulence factors