title: Vaginal versus Obstetric Infection Escherichia coli Isolates among Pregnant Women: Antimicrobial Resistance and Genetic Virulence Profile.
abstract: Vaginal Escherichia coli colonization is related to obstetric infections and the consequent development of infections in newborns. Ampicillin resistance among E. coli strains is increasing, which is the main choice for treating empirically many obstetric and neonatal infections. Vaginal E. coli strains are very similar to extraintestinal pathogenic E. coli with regards to the virulence factors and the belonging to phylogroup B2. We studied the antimicrobial resistance and the genetic virulence profile of 82 E. coli isolates from 638 vaginal samples and 63 isolated from endometrial aspirate, placental and amniotic fluid samples from pregnant women with obstetric infections. The prevalence of E. coli in the vaginal samples was 13%, which was significant among women with associated risk factors during pregnancy, especially premature preterm rupture of membranes (p<0.0001). Sixty-five percent of the strains were ampicillin-resistant. The E. coli isolates causing obstetric infections showed higher resistance levels than vaginal isolates, particularly for gentamicin (p = 0.001). The most prevalent virulence factor genes were those related to the iron uptake systems revealing clear targets for interventions. More than 50% of the isolates belonged to the virulent B2 group possessing the highest number of virulence factor genes. The ampicillin-resistant isolates had high number of virulence factors primarily related to pathogenicity islands, and the remarkable gentamicin resistance in E. coli isolates from women presenting obstetric infections, the choice of the most appropriate empiric treatment and clinical management of pregnant women and neonates should be carefully made. Taking into account host-susceptibility, the heterogeneity of E. coli due to evolution over time and the geographical area, characterization of E. coli isolates colonizing the vagina and causing obstetric infections in different regions may help to develop interventions and avoid the aetiological link between maternal carriage and obstetric and subsequent puerperal infections.
authors.affiliation: Department of Microbiology, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.|ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors.forename: Emma
authors.initials: E
authors.lastname: Sáez-López
authors.affiliation: Department of Microbiology, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.|ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Guiral
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Fernández-Orth
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Villanueva
authors.affiliation: BCNatal-Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain.|Institut D´Investigacions Biomèdiques August Pi I Sunyer (DIBAPS), Barcelona, Spain.|University of Barcelona, Barcelona, Spain.|Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Goncé
authors.affiliation: BCNatal-Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain.|Institut D´Investigacions Biomèdiques August Pi I Sunyer (DIBAPS), Barcelona, Spain.|University of Barcelona, Barcelona, Spain.|Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: López
authors.affiliation: BCNatal-Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain.|Institut D´Investigacions Biomèdiques August Pi I Sunyer (DIBAPS), Barcelona, Spain.|University of Barcelona, Barcelona, Spain.|Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Teixidó
authors.affiliation: BCNatal-Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain.|Institut D´Investigacions Biomèdiques August Pi I Sunyer (DIBAPS), Barcelona, Spain.|University of Barcelona, Barcelona, Spain.|Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Pericot
authors.affiliation: BCNatal-Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain.|Institut D´Investigacions Biomèdiques August Pi I Sunyer (DIBAPS), Barcelona, Spain.|University of Barcelona, Barcelona, Spain.|Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Figueras
authors.affiliation: BCNatal-Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain.|Institut D´Investigacions Biomèdiques August Pi I Sunyer (DIBAPS), Barcelona, Spain.|University of Barcelona, Barcelona, Spain.|Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Montse
authors.initials: M
authors.lastname: Palacio
authors.affiliation: BCNatal-Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain.|Institut D´Investigacions Biomèdiques August Pi I Sunyer (DIBAPS), Barcelona, Spain.|University of Barcelona, Barcelona, Spain.|Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cobo
authors.affiliation: Department of Microbiology, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.|ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bosch
authors.affiliation: Department of Microbiology, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.|ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Soto
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D004352:Drug Resistance, Microbial / Q000235:genetics; D004926:Escherichia coli / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009018:Morocco / Q000453:epidemiology; D009073:Mozambique / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D014621:Vagina / Q000382:microbiology*; D037521:Virulence Factors / Q000235:genetics*
chemical_list: D000890:Anti-Infective Agents; D037521:Virulence Factors