Molecular Characterization of High and Low Virulent Clinical Strains Isolated from Patients with Urinary Tract Infections with or Without Bacteremia in Southern Taiwan

Overview

Journal Infect Drug Resist

Publisher Dove Medical Press

Date 2024 Jun 21

PMID 38903152

Authors

Chih-Yen Hsiao

Yi-Chien Lee

Douglas J H Shyu

Che-Ping Su

Man-Yi Lin

Nai-Yu Guo

Cheng-Lun Chiang

Yih-Yuan Chen

Affiliations

Soon will be listed here.

Abstract

Objective: The most common extraintestinal pathogen and infection site is uropathogenic (UPEC), which causes urinary tract infections (UTIs). UPEC is also a common pathogen in bloodstream infections; in severe cases, it can lead to death. Although host and bacterial virulence factors have been demonstrated to be associated with UTI pathogenesis, the role of the related contributing factors in UTI and urinary source bacteremia is not yet fully understood. This study aimed to compare and analyze the factors contributing to urinary bacteremia in patients with UTI.

Methods: A total of 171 strains collected from patients with UTI and urinary source bacteremia at Chiayi Christian Hospital were used. Phylogenetic groups and virulence factors were determined using PCR. Drug resistance patterns were determined using the disk diffusion assay.

Results: Previous studies have demonstrated that fimbriae and papGII may be associated with first-step infections and severe UTIs, respectively. As expected, highly virulent strains (belonging to the phylogenetic B2 and D groups) were dominant in the bacteremic UTI (90%) and UTI (86.27%) groups. However, our results showed that the UTI group had a significantly higher prevalence of (belonging to the S and FIC fimbriae) than the bacteremic UTI group (29.4% vs 12.5%; p=0.008). In the bacteremic group, we found that / was only detected in highly virulent strains. The bacteremic UTI group had a significantly higher prevalence of GII (belonging to P fimbriae) than the UTI group (55.8% vs 37.3%; p=0.026). In addition, the P fimbriae gene cluster, including , and , was predominant in highly virulent strains. Notably, our results show that multidrug-resistant (MDR) strains were significantly less virulent than non MDR strains.

Conclusion: Taken together, our results provide insights into the contributing factors in patients with UTI and urinary bacteremia.

Citing Articles

Analysis of phylogroups, biofilm formation, virulence factors, antibiotic resistance and molecular typing of uropathogenic Escherichia coli strains isolated from patients with recurrent and non-recurrent urinary tract infections.

Mahshouri P, Alikhani M, Momtaz H, Doosti-Irani A, Shokoohizadeh L BMC Infect Dis. 2025; 25(1):267.

PMID: 39994590 PMC: 11853791. DOI: 10.1186/s12879-025-10635-w.

References

Mancuso G, Midiri A, Gerace E, Marra M, Zummo S, Biondo C . Urinary Tract Infections: The Current Scenario and Future Prospects. Pathogens. 2023; 12(4). PMC: 10145414. DOI: 10.3390/pathogens12040623. View

Diard M, Hardt W . Evolution of bacterial virulence. FEMS Microbiol Rev. 2017; 41(5):679-697. DOI: 10.1093/femsre/fux023. View

Kao C, Zhang Y, Yang D, Chen P, Teng C, Lin W . Characterization of host and escherichia coli strains causing recurrent urinary tract infections based on molecular typing. BMC Microbiol. 2023; 23(1):90. PMC: 10061793. DOI: 10.1186/s12866-023-02820-1. View

Yi-Te C, Shigemura K, Nishimoto K, Yamada N, Kitagawa K, Sung S . Urinary tract infection pathogens and antimicrobial susceptibilities in Kobe, Japan and Taipei, Taiwan: an international analysis. J Int Med Res. 2019; 48(2):300060519867826. PMC: 7593667. DOI: 10.1177/0300060519867826. View

Hagan E, Lloyd A, Rasko D, Faerber G, Mobley H . Escherichia coli global gene expression in urine from women with urinary tract infection. PLoS Pathog. 2010; 6(11):e1001187. PMC: 2978726. DOI: 10.1371/journal.ppat.1001187. View

Struve C, Krogfelt K . In vivo detection of Escherichia coli type 1 fimbrial expression and phase variation during experimental urinary tract infection. Microbiology (Reading). 1999; 145 ( Pt 10):2683-90. DOI: 10.1099/00221287-145-10-2683. View

Barnett B, Stephens D . Urinary tract infection: an overview. Am J Med Sci. 1997; 314(4):245-9. DOI: 10.1097/00000441-199710000-00007. View

Krachler A, Orth K . Targeting the bacteria-host interface: strategies in anti-adhesion therapy. Virulence. 2013; 4(4):284-94. PMC: 3710331. DOI: 10.4161/viru.24606. View

Ejrnaes K . Bacterial characteristics of importance for recurrent urinary tract infections caused by Escherichia coli. Dan Med Bull. 2011; 58(4):B4187. View

10.

Kim B, Kim J, Lee Y . Virulence Factors Associated With Bacteremia and Urinary Tract Infection. Ann Lab Med. 2021; 42(2):203-212. PMC: 8548248. DOI: 10.3343/alm.2022.42.2.203. View

11.

Yousefipour M, Rezatofighi S, Roayaei Ardakani M . Detection and characterization of hybrid uropathogenic strains among isolates causing community-acquired urinary tract infection. J Med Microbiol. 2023; 72(2). DOI: 10.1099/jmm.0.001660. View

12.

Clermont O, Bonacorsi S, Bingen E . Rapid and simple determination of the Escherichia coli phylogenetic group. Appl Environ Microbiol. 2000; 66(10):4555-8. PMC: 92342. DOI: 10.1128/AEM.66.10.4555-4558.2000. View

13.

Pak J, Pu Y, Zhang Z, Hasty D, Wu X . Tamm-Horsfall protein binds to type 1 fimbriated Escherichia coli and prevents E. coli from binding to uroplakin Ia and Ib receptors. J Biol Chem. 2001; 276(13):9924-30. DOI: 10.1074/jbc.M008610200. View

14.

Zamora M, Ziegler C, Freddolino L, Freddolino P, Wolfe A . A Thermosensitive, Phase-Variable Epigenetic Switch: Revisited. Microbiol Mol Biol Rev. 2020; 84(3). PMC: 7392537. DOI: 10.1128/MMBR.00030-17. View

15.

Lin W, Wang M, Liu P, Chen P, Wen L, Teng C . Escherichia coli urinary tract infections: Host age-related differences in bacterial virulence factors and antimicrobial susceptibility. J Microbiol Immunol Infect. 2021; 55(2):249-256. DOI: 10.1016/j.jmii.2021.04.001. View

16.

Cayo R, Rodriguez M, Espinal P, Fernandez-Cuenca F, Ocampo-Sosa A, Pascual A . Analysis of genes encoding penicillin-binding proteins in clinical isolates of Acinetobacter baumannii. Antimicrob Agents Chemother. 2011; 55(12):5907-13. PMC: 3232777. DOI: 10.1128/AAC.00459-11. View

17.

Khan A, Kniep B, Oelschlaeger T, van Die I, Korhonen T, Hacker J . Receptor structure for F1C fimbriae of uropathogenic Escherichia coli. Infect Immun. 2000; 68(6):3541-7. PMC: 97640. DOI: 10.1128/IAI.68.6.3541-3547.2000. View

18.

Beceiro A, Tomas M, Bou G . Antimicrobial resistance and virulence: a successful or deleterious association in the bacterial world?. Clin Microbiol Rev. 2013; 26(2):185-230. PMC: 3623377. DOI: 10.1128/CMR.00059-12. View

19.

Rodriguez-Bano J, Mingorance J, Fernandez-Romero N, Serrano L, Lopez-Cerero L, Pascual A . Virulence profiles of bacteremic extended-spectrum β-lactamase-producing Escherichia coli: association with epidemiological and clinical features. PLoS One. 2012; 7(9):e44238. PMC: 3436869. DOI: 10.1371/journal.pone.0044238. View

20.

Nielubowicz G, Mobley H . Host-pathogen interactions in urinary tract infection. Nat Rev Urol. 2010; 7(8):430-41. DOI: 10.1038/nrurol.2010.101. View