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Meta-Analysis
. 2021 Aug 4;21(1):753.
doi: 10.1186/s12879-021-06435-7.

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

Gabriel Kambale Bunduki  1   2   3   4 , Eva Heinz  5 , Vincent Samuel Phiri  6 , Patrick Noah  7 , Nicholas Feasey  8   5 , Janelisa Musaya  9   8
Affiliations
Meta-Analysis

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

Gabriel Kambale Bunduki et al. BMC Infect Dis. .

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.

Keywords: Antimicrobial resistance; Escherichia coli; Meta-analysis; Systematic review; Urinary tract infection; Virulence factors.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The PRISMA flowchart for literature search and study selection
Fig. 2
Fig. 2
Forest plot of UPEC resistance to different antibiotic subgroups (A main antibiotic groups, B Beta-lactams classes, C Cephalosporins classes) and virulence factors groups (D)
See this image and copyright information in PMC

References

    1. Terlizzi ME, Gribaudo G, Maffei ME. UroPathogenic Escherichia coli (UPEC) infections : virulence factors, bladder responses, antibiotic and non-antibiotic antimicrobial strategies. Front Microbiol. 2017;8:1566. doi: 10.3389/fmicb.2017.01566. - DOI - PMC - PubMed
    1. Raeispour M, Ranjbar R. Antibiotic resistance , virulence factors and genotyping of Uropathogenic Escherichia coli strains. Antimicrob Resist Infect Control. 2018;7(1):118. doi: 10.1186/s13756-018-0411-4. - DOI - PMC - PubMed
    1. Bien J, Sokolova O, Bozko P. Role of uropathogenic Escherichia coli virulence factors in development of urinary tract infection and kidney damage. Int J Nephrol. 2012:681473. 10.1155/2012/687473. - PMC - PubMed
    1. Calhau V, Domingues S, Mendonc N, Jorge G, Silva D, Jorge G, et al. Interplay between pathogenicity island carriage, resistance profile and plasmid acquisition in uropathogenic Escherichia coli. J Med Microbiol. 2015;64(8):828–835. doi: 10.1099/jmm.0.000104. - DOI - PubMed
    1. Partridge SR, Kwong SM, Firth N, Jensen SO. Mobile genetic elements associated with antimicrobial resistance. Clin Microbiol Rev. 2018;31(4):e00088–e00017. doi: 10.1128/CMR.00088-17. - DOI - PMC - PubMed

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