[01] Narmin S. Merza, Scientific Research Centre, Faculty of Science, Dohuk University, Duhok, Iraq. [02] Jaladet M. S. Jubrael, Scientific Research Centre, Faculty of Science, Dohuk University, Duhok, Iraq.

In this study, 150 isolates of Uropathogenic Escherichia coli (UPEC) strains have been collected from different major hospitals in Kurdistan region and showed high resistant rates to most tested antibiotics accounting for 98%. There was no isolate that had demonstrated sensitive to all antibiotics, but they manifested with a wide range of resistance to most tested antibiotics ranging from resistance to just two antibiotics (2%) to resistance to 15 out of 16 tested antibiotics (9.3%). Imipenem was found as the most potent at all other antimicrobial agents with the resistance rate (4.7%), whereas Tetracycline, Ampicillin, Amoxicillin and Amoxicillin / Clavulanic acid had the least effect on UPEC strains with resistant rates of 83.3%, 92.6%, 90.6% and 90% respectively. The resistance patterns of Chloramphenicol, Norfloxacin, Ciprofloxacin and Nalidixic acid were 30%, 48.6%, 52.6% and 78% respectively. Amikacin, Gentamicin, Trimethoprim and Trimethoprim/ sulfamethoxazole antibiotics also showed low effect on tested isolates with resistant rates 46%, 70.7%, 77.3% and 73.3%. Cephalosporins including; Cefixime, Cefotaxime, Ceftriaxone with resistance rates of 78%, 78% and 71.3% respectively. The results of the detection five virulence related genes including; (cnf, hyl, sfa, afa, and pai) revealed that fifteen of these isolates accounting (10%) lacked any tested virulence markers. pai as a marker for presence of pathogenicity island was the most predominant marker among all other virulence markers accounting 110(73.3%) followed by cnf and hyl accounting 64(42.7%) and 61(40.6%) respectively, while the prevalence of sfa gene is found with the rate 34(22.7%) and afa with 27(18%).

Virulence Factors, Uropathogenic Escherichia coli (UPEC), Antibiotics

[01] Bien, J.; Sokolova, O., and Bozko, P. (2012). Role of Uropathogenic Escherichia coli Virulence Factors in Development of Urinary Tract Infection and Kidney Damage. International Journal of Nephrology, Volume 2012, Article ID 681473, pp. 1-15. [02] Blanco, M. J. E.; Blanco, M.; Alonso, P., and Blanco, J. (1996). Virulence factors and O groups of Escherichia coli isolates from patients with acute pyelonephritis, cystitis and asymptomatic bacteriuria. Eur. J. Epidemiol. 12(2): 191-198. (Abstract). [03] Bower, J. M.; Eto, D. S. & Mulvey, M. A. (2005). Covert operations of uropathogenic Escherichia coli within the urinary tract. Traffic 6(1): 18-31. [04] Brzuszkiewicz, E.; Bruggemann, H.; Liesegang, H.; Emmerth, M.; Olschlager, T.; Nagy, G.; et al. (2006) How to become an uropathogen: comparative genomic analysis of extraintestinal pathogenic Escherichia coli strains. Proc Natl Acad Sci; 103 (34): 12879-84. [05] Chapman, T. A.; Wu, X. Y.; Barchia, I.; Bettelheim, K. A.; Driesen, S.; Trott, D.; Wilson, M., and Chin, J. J. C. (2006). Comparison of Virulence Gene Profiles of Escherichia coli Strains Isolated from Healthy and Diarrheic Swine. Appl. Environ. Microbiol. 72(7): 4782. [06] CLSI, Clinical and Laboratory Standards Institute (2007). Performance standards for antimicrobial susceptibility testing; seventeenth informational supplement. M100-17. Clinical and Laboratory Standards Institute, Wayne, PA. [07] Dash, M.; Padhi, S.; Mohanty, I.; Panda, P., and Parida, B. (2013). Antimicrobial resistance in pathogens causing urinary tract infections in a rural community of Odisha, India, J Family Community Med., 20(1): 20–26. [08] Gupta, K.; Hooton, T. M.; Naber, K. G.; Wullt, B.; Colgan, R.; Miller, L. G.; Moran, G. J.; Nicolle, L. E.; Raz, R.; Schaeffer, A. J., and Soper, D. E. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis., 52(5): 103-120. [09] Hacker, J. and Kaper, J. B. (2000). Pathogenicity islands and the evolution of microbes. Annu. Rev. Microbiol., 54: 641-679 [10] Hilbert, D. W. (2011). Antibiotic Resistance in Urinary Tract Infections: Current Issues and Future Solutions. Tenke Peter (2011) Urinary Tract Infections, chapter 11, 193-208, ISBN: 978-953-307-757-4. [11] Hodiwala, A.; Dhoke, R., and Urhekar, A. D. (2013). Incidence of Metalo-Beta- Lactamse producing Pseudomonas, Acinetobacter and Enterobacterial isolates in Hospitalized Patients. IJPBS, (3) 1: 79-83 [12] Hryniewicz K, Szczypa K, Sulikowska A, Jankowski K, Betlejewska K, Hryniewicz W. (2001). Antibiotic susceptibility of bacterial strains isolated from urinary tract infections in Poland. J Antimicrob Chemother; 47: 773-80 cited by Massoud Boussina Z., El Sherbini Eglal A., Rizk Nagwa G, Arafa Shams A. (2007). Characterization of Uropathogenic Escherichia coli Strains Isolated from Community Acquired and Hospital Acquired Infections in Alexandria, Egyptian Journal of Medical Microbiology; 16(3): 513-520. [13] Karimian, A.; Momtaz, H., and Madani, M. (2012). Detection of uropathogenic Escherichia coli virulence factors in patients with urinary tract infections in Iran. African Journal of Microbiology Research, 6(39): 6811-6816. [14] Le, Bouguenec C.; Archambaud, M., and Labigne, A. (1992). Rapid and specific detection of the pap, afa, and sfa adhesion-encoding operons in uropathogenic Escherichia coli strains by polymerase chain reaction. J. clin. Microbiol., 30: 1189-1193. [15] Luzzaro F, Mezzatesa M, Mugnaioli C, Perilli M, Stefani S Amicosante G, Rossolini GM, Toniolo A. (2006). Trends in production of extended spectrum β-lactamase among Enterobacteria of medical interest: Report of the Second Italian Nationwide Survey. J Clin Microbiol; 44(5): 1659-64.cited by Massoud Boussina Z., El Sherbini Eglal A., Rizk Nagwa G, Arafa Shams A. (2007). Characterization of Uropathogenic Escherichia coli Strains Isolated from Community Acquired and Hospital Acquired Infections in Alexandria, Egyptian Journal of Medical Microbiology; 16(3): 513-520. [16] Manges A. R., Johnson J. R., Foxman B., O. Bryan T. T., Fullerton K. E., Riley L. W. (2001). Widespread distribution of urinary tract infections caused by a multidrug- resistant Escherichia coli clonal group. N Eng J Med; 345(14): 1007-13. [17] Massoud Boussina Z., El Sherbini Eglal A., Rizk Nagwa G, Arafa Shams A. (2007). Characterization of Uropathogenic Escherichia coli Strains Isolated from Community Acquired and Hospital Acquired Infections in Alexandria, Egyptian Journal of Medical Microbiology; 16(3): 513-520. [18] Miyazaki, J., Ba-Thein, W., Kumao, T., Yasuoka, M. O., Akaza, H., and Hayshi, H. (2002). Type 1, P and S fmbriae, and afimbrial adhesinI are not essential for uropathogenic Escherichia coli to adhere to and invade bladder epithelial cells. FEMS Immunology and Medical Microbiology 33: 23-26. [19] Mladin, C.; Usein, C. A.; Chifiric, M. C.; Palade, A.; Slavu, C. L.; Negut, M., and et al., (2009). Genetic analysis of virulence and pathogenicity features of uropathogenic Escherichia coli isolated from patietns with neurogenic bladder. Romanian Biotechnological Letters, (14)6: 4900-4905. [20] Mobley H. L. (2000). Virulence of the two primary uropathogens. ASM News; 66: 403-10. [21] Mukherjee, M.; Basu, S.; Mukherjee, S. K., and Globe, M. M. (2013). Multidrug-Resistance and Extended Spectrum Beta-Lactamase Production in Uropathogenic E. coli which were Isolated from Hospitalized Patients in Kolkata, India. Journal of Clinical and Diagnostic Research, 7(3): 449-453 [22] Navidinia, M.; Peerayeh, S. N.; Fallah, F.; Bakhshi, B.; Adabian, S.; Alimehr, S.; Gholinejad, Z., and Malekan, M. A. (2012). Phylogenic Typing of Urinary E coli isolates and commensal E. coli in patients with UTI in mofid children hospital in Iran. Arch. Dis. child., 97 (Abstract). [23] Nazik, H.; Öngen, B.; Yildirim, E. E., and Ermi, F. (2011). High prevalence of CTX-M-type beta-lactamase in Escherichia coli isolates producing extended-spectrum beta-lactamase (ESBL) and displaying antibiotic co-resistance. African Journal of Microbiology Research. 5(1): 44-49. [24] Nicolle, L. E. (2005). Complicated urinary tract infection in adults. Can J Infect Dis Med Microbiol. 16(6): 349–360. [25] Nordstrom, L.; Liu, C. M., and Price, L. B. (2013) Food borne urinary tract infections: a new paradigm for anti-microbial-resistant food borne illness Frontiers in Microbiology. 4(29): 1-6. [26] Oliveira, F. A.; Paludo, K. S.; Arend, L. N. V. S.; Farah, S. M. S. S.; Pedrosa, F. O.; Souza, E. M.; Surek, M.; Picheth, G., and Fadel-Picheth, C. M. T. (2011). Virulence characteristics and antimicrobial susceptibility of uropathogenic Escherichia coli strains. Genet. Mol. Res., 10(4): 4114-4125. [27] Paterson, D. L. (2006). Resistance in gram-negative bacteria: Enterobacteriaceae, J. AJI C, (34):5, 20-28. [28] Rasol, S. H. (2013). Identification of a Number of Escherichia Coli Virulence Genes from Urine Samples in UTI Patients Using SSR-PCR Technique, in Duhok and Zakho. MSc. Thesis, College of Medicine, University of Duhok, Iraq. [29] Rezaee, M. A.; Sheikhalizadeh,V., and Hasani, A. (2011). Detection of integrons among multi-drug resistant (MDR) Escherichia coli strains isolated from clinical specimens in northern west of Iran. Braz. J. Microbiol. 42 (4): 1308-1313 [30] Slavchev, G., Pisareva, E., and Markova, N. (2008). Virulence of uropathogenic Escherichia coli, Journal of Culture Collections., 6: 3-9. [31] Smith, Y. C.; Rasmussen, S. B.; Grande, K. K.; Conran, R. M., and O’Brien, A. D. (2008). Hemolysin of Uropathogenic Escherichia coli Evokes Extensive Shedding of the Uroepithelium and Hemorrhage in Bladder Tissue within the First 24 Hours after Intraurethral Inoculation of Mice. Infection and Immunity, 76(7): 2978–2990. [32] Starčič-Erjavec, M.; Križan-Hergouth, V.; Gubina, B., and Žgur-Bertok, D. (2008). Prevalence of toxin encoding genes in Escherichia coli isolated from urinary tract infections in Slovenia. Zdrav Vestn., 77: 427–432. [33] Totsika, M.; Moriel, D. G.; Idris, A.; Rogers, B. A.; Wurpel, D. J.; Phan, M.; Paterson, D. L., and Schembri, M. A. (2012). Uropathogenic Escherichia coli Mediated Urinary Tract Infection. Current Drug Targets. 13(11): 1386-1399. [34] Van de, S. N.; Grundmann, H.; Verloo, D.; Tiemersma, E.; Monen, J.; Goossens, H.; Ferech, M.; European Antimicrobial Resistance Surveillance System Group, and European Surveillance of Antimicrobial Consumption Project Group. (2008). Antimicrobial drug use and resistance in Europe. Emerg Infect Dis, 14: 1722-1730. [35] Warren, J. W.; Abrutyn, E.; Hebel, J. R.; James, R. J.; Anthony, J. S., and Stamm, W. E. (1999). Guidelines for Antimicrobial Treatment of Uncomplicated Acute Bacterial Cystitis and Acute Pyelonephritis in Women, Clinical Infectious Diseases; 29: 745–58. [36] Wiles, T. J., and Mulvey M. A. (2013). The RTX pore-forming toxin α-hemolysin of uropathogenic Escherichia coli: progress and perspectives. Future Microbiology, 8(1): 73-84. [37] Wiles, T. J.; Kulesus, R. R., and Mulvey, M. A. (2008). Origins and virulence mechanisms of uropathogenic Escherichia coli. Experimental and Molecular Pathology, 85: 11–19. [38] Yasufuku, T.; Shigemura, K.; Shirakawa, T.; Matsumoto, M.; Nakano, Y.; Tanaka, K.; Arakawa, S.; Kinoshita, S.; Kawabata, M., and Fujisawa, M. (2011). Correlation of overexpression of efflux pump genes with antibiotic resistance in Escherichia coli Strains clinically isolated from urinary tract infection patients. J Clin Microbiol. 49(1): 189-94.