Prevalence of Extended-Spectrum B-Lactamase (ESBL) and Quinolone Resistance (qnr) Genes among Cytotoxic Necrotizing Factor-1-Producing Uropathogenic Escherichia coli in Babylon, Iraq

Abstract

Background: Pathogenic Escherichia coli (E. coli) is usually known as the principal agent of hospital-acquired infections, particularly urinary tract infections (UTIs). This study aimed to determine ESBL (extended-spectrum B-lactamase) production and quinolone resistance (qnr) genes in cytotoxic necrotizing factor 1 (CNF-1)-producing E. coli isolates from UTIs in Iraq. Materials & Methods: A total of 996 E. coli isolates were obtained from UTIs in two general hospitals in Hillah, Babylon, Iraq (during 2014-2022), and 100 uropathogenic E. coli (UPEC) were cnf-1 carriers. ESBL production was evaluated using the double-disk synergy test. qnr genes were detected using polymerase chain reaction (PCR). Findings: Nalidixic acid and chloramphenicol resistance was 70 and 30%, respectively. ESBL production was observed among 46% of cnf-1 carriers. qnrA, qnrB, and qnrS genes were detected in 18, 21, and 11% of the isolates, respectively. ESBL-producing isolates mainly carried the qnrB gene and showed the highest resistance levels to quinolones. Major risk factors of pathogenic E. coli isolation included older age (68%, p=.031), previous hospitalization (76%, p=.021), and urinary catheter (83%, p=.018). Conclusion: Although the prevalence of cnf-1 gene was not high among UPEC isolates, its prevalence was high among quinolone-resistant and ESBL-producing isolates. Continuous investigation of virulence and resistance genes is essential for monitoring and controlling infections. It is necessary to determine virulence factors and resistance genes among UPEC in Iraq and take timely measures to hinder the spread of resistance genes to other nosocomial isolates.