Virulence factors and antimicrobial resistance of uropathogenic Escherichia coli (UPEC) isolated from urinary tract infections: a systematic review and meta-analysis.

Abstract

BACKGROUND:

Uropathogenic Escherichia coli (UPEC) are amongst the most frequent causes of urinary tract infections. We report a systematic review and meta-analysis of virulence factors and antimicrobial resistance of UPEC isolated from urinary tract infections.

METHODS:

A systematic review and meta-analysis were performed using PRISMA guidelines (Research Registry ref. 5874). Data were extracted from PubMed/MEDLINE and ScienceDirect databases for studies published from January 1, 2000 to December 31, 2019. Studies reporting antimicrobial resistance and virulence factors of UPEC isolated in confirmed urinary tract infections (≥105CFU/ml) were eligible. Prevalence of antimicrobial resistance and virulence factors of UPEC were estimated using random-effects meta-analysis model. Estimates with 95% confidence intervals, I-square (I2) statistic, and Cochran's Q test were computed using the score statistic and the exact binomial method by incorporating the Freeman-Tukey double arcsine transformation of proportions.

RESULTS:

Our search returned 2504 hits, of which 13 studies were included in the meta-analysis, totalling 1888 UPEC isolates. Highest antimicrobial resistance rates were observed among the antibiotic class of tetracycline in 69.1% (498/721), followed by sulphonamides in 59.3% (1119/1888), quinolones in 49.4% (1956/3956), and beta-lactams in 36.9% (4410/11964). Among beta-lactams, high resistance was observed in aminopenicillins in 74.3% (1157/1557) and first generation cephalosporins in 38.8% (370/953). Meanwhile, virulence factors with highest prevalence were immune suppressors (54.1%) followed by adhesins (45.9%). Taken individually, the most observed virulence genes were shiA (92.1%), CSH (80.0%), fimH/MSHA (75.3%), traT (75.1%), sisA (72.2%), iucD (65.7%), iutA (61.8%), kpsMTII (60.6%), and PAI (55.2%).

CONCLUSIONS:

The increased antibiotic resistance of UPEC isolates was demonstrated and suggested a need for reassessment of empirical therapies in urinary tract infections treatment caused by this pathogen. In addition, this pathotype exhibited diverse surface and secreted virulence factors.

• Authors: Gabriel Kambale Bunduki, Eva Heinz, Vincent Samuel Phiri, Patrick Noah, Nicholas Feasey, Janelisa Musaya
• Journal: BMC infectious diseases (BMC Infect Dis) Vol. 21 Issue 1 Pg. 753 (Aug 04 2021) ISSN: 1471-2334 [Electronic] England
• PMID: 34348646 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: © 2021. The Author(s).

Chemical References

• Anti-Bacterial Agents
• Virulence Factors

Topics

• Anti-Bacterial Agents (pharmacology, therapeutic use)
• Drug Resistance, Bacterial
• Escherichia coli Infections (drug therapy, epidemiology)
• Humans
• Urinary Tract Infections (drug therapy, epidemiology)
• Uropathogenic Escherichia coli (genetics)
• Virulence Factors (genetics)