Caracterización fenotípica y genotípica de uropatógenos resistentes a antimicrobianos en entornos comunitarios de la...

This study determines the prevalence and genomic characterisation of uropathogens causing community-acquired urinary tract infections (CA-UTIs).

This is a first multi-centric cross-sectional community study conducted across different regions of India, in patients aged >1.5 years suspected with UTI. Uropathogens causing significant bacteriuria were identified, and susceptibility testing was performed. Whole-genome sequencing (WGS) was done to characterise antimicrobial resistance (AMR) genes, virulence genes, and sequence types (ST). The effect of age and gender on significant bacteriuria was assessed by Multivariable random-effects logistic regression.

Significant bacteriuria was seen in 11.8% (711/6,009) of the specimens out of which, 63% (448/711) were Escherichia coli; and 15.7% (112/711) were Klebsiella pneumoniae. The prevalence of extended-spectrum-beta-lactamase (ESBL) positive, multidrug-resistant (MDR) and carpabenem resistant E. coli was 39.2% (44/112), 64.5% (289/488) and 9.82% (44/448); among K. pneumoniae isolates, similar resistance was seen in 56.2% (63/112), 65.4% (293/448), and 9.82% (11/112), respectively. Genomic analysis showed high-risk clones of E. coli (ST131, ST1193) and K. pneumoniae (ST15, ST16, and ST231) carrying multiple plasmids with bla_CTX-M-15, bla_OXA-232, bla_NDM-5, and bla_NDM-7 genes.

This study revealed a wider presence of drug resistant high-risk clones of uropathogens in community-settings of India. A multifaceted approach through routine AMR surveillance, judicious choice of empiric antibiotics in a community-setting, is deemed necessary. WGS analysis of ESBL-producing E. coli isolates revealed a predominance of ST131 lineage (25%), while ST1193 strains carried IncFIA and ColKP3 plasmids associated with bla_CTX-M-15 and bla_TEM-1B. ST231 K. pneumoniae isolates harboured bla_OXA-32 gene along with ColKP3 plasmid.