title: Multidrug- and Extensively Drug-Resistant UropathogenicEscherichia coliClinical Strains: Phylogenetic Groups Widely Associated with Integrons Maintain High Genetic Diversity.
abstract: In recent years, an increase of uropathogenicEscherichia coli(UPEC) strains with Multidrug-resistant (MDR) and Extensively Drug-resistant (XDR) profiles that complicate therapy for urinary tract infections (UTIs) has been observed and has directly impacted costs and extended hospital stays. The aim of this study was to determine MDR- and XDR-UPEC clinical strains, their virulence genes, their phylogenetic groups and to ascertain their relationship with integrons and genetic diversity. From a collection of 500 UPEC strains, 103 were selected with MDR and XDR characteristics. MDR-UPEC strains were mainly associated with phylogenetic groups D (54.87%) and B2 (39.02%) with a high percentage (≥70%) of several fimbrial genes (ecpA, fimH, csgA, andpapGII), an iron uptake gene (chuA), and a toxin gene (hlyA). In addition, a moderate frequency (40-70%) of other genes (iutD, tosA, andbcsA) was observed. XDR-UPEC strains were predominantly associated with phylogenetic groups B2 (47.61%) and D (42.85%), which grouped with ≥80 virulence genes, includingecpA, fimH, csgA, papGII,iutD, andchuA. A moderate frequency (40-70%) of thetosAandhlyAgenes was observed. The class 1 and 2 integrons that were identified in the MDR- and XDR-UPEC strains were associated with phylogenetic groups D, B2, and A, while the XDR-UPEC strains that were associated with phylogenetic groups B2, D, and A showed an extended-spectrum beta-lactamase (ESBL) phenotype. The modifying enzymes (aadA1,aadB,aacC,ant1,dfrA1,dfrA17, andaadA4) that were identified in the variable region of class 1 and 2 integrons from the MDR strains showed resistance to gentamycin (56.25 and 66.66%, respectively) and trimethoprim-sulfamethoxazole (84.61 and 66.66%, respectively). The MDR- and XDR-UPEC strains were distributed into seven clusters and were closely related to phylogenic groups B2 and D. The diversity analysis by PFGE showed 42.68% of clones of MDR-UPEC and no clonal association in the XDR-UPEC strains. In conclusion, phylogenetic groups including virulence genes are widely associated with two integron classes (1 and 2) in MDR- and XDR-UPEC strains.
authors.affiliation: Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico GómezMexico City, Mexico; Posgrado en Ciencias Químico-Biológicas, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico NacionalMexico City, Mexico; Laboratorio de Bacteriología Médica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico NacionalMexico City, Mexico.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Ochoa
authors.affiliation: Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez Mexico City, Mexico.
authors.forename: Ariadnna
authors.initials: A
authors.lastname: Cruz-Córdova
authors.affiliation: Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez Mexico City, Mexico.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Luna-Pineda
authors.affiliation: Laboratorio de Estructura de Proteínas, Instituto Nacional de Medicina Genómica Mexico City, Mexico.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Reyes-Grajeda
authors.affiliation: Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez Mexico City, Mexico.
authors.forename: Vicenta
authors.initials: V
authors.lastname: Cázares-Domínguez
authors.affiliation: Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez Mexico City, Mexico.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Escalona
authors.affiliation: Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez Mexico City, Mexico.
authors.forename: Ma Eugenia
authors.initials: ME
authors.lastname: Sepúlveda-González
authors.affiliation: Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez Mexico City, Mexico.
authors.forename: Fernanda
authors.initials: F
authors.lastname: López-Montiel
authors.affiliation: Área de Virología, Laboratorio de Infectología, Hospital Infantil de México Federico Gómez Mexico City, Mexico.
authors.forename: José
authors.initials: J
authors.lastname: Arellano-Galindo
authors.affiliation: Subdirección de Servicios Auxiliares de Diagnóstico, Hospital Infantil de México Federico Gómez Mexico City, Mexico.
authors.forename: Briceida
authors.initials: B
authors.lastname: López-Martínez
authors.affiliation: Laboratorio Clínico, Hospital Infantil de México Federico Gómez Mexico City, Mexico.
authors.forename: Israel
authors.initials: I
authors.lastname: Parra-Ortega
authors.affiliation: Laboratorio de Bacteriología Médica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional Mexico City, Mexico.
authors.forename: Silvia
authors.initials: S
authors.lastname: Giono-Cerezo
authors.affiliation: Departamento de Ecología de Agentes Patógenos, Hospital General "Dr. Manuel Gea González," Mexico City, Mexico.
authors.forename: Rigoberto
authors.initials: R
authors.lastname: Hernández-Castro
authors.affiliation: Epidemiología Hospitalaria, Hospital Infantil de México Federico Gómez Mexico City, Mexico.
authors.forename: Daniela
authors.initials: D
authors.lastname: de la Rosa-Zamboni
authors.affiliation: Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez Mexico City, Mexico.
authors.forename: Juan
authors.initials: J
authors.lastname: Xicohtencatl-Cortes
keywords: PFGE; UPEC; multidrug resistance; phylogenetic groups; virulence genes