Resistant Gene Profiling Of E. coli Isolates Among Pregnant Women With Urinary Tract Infections At Kisii Teaching And Referral Hospital Kenya

Abstract

The bacterium Escherichia coli is known to cause urinary tract infections (UTIs) and has been linked to human drug resistance. This study determined its prevalence among pregnant women seeking Medicare at Kisii Referral Hospital (KTRH), together with other bacteria that cause UTIs. It further profiled its drug susceptibility patterns, resistant genes and antibiofilm formation activity. The study was conducted between March and June of 2020, using cross sectional study design. The urine samples from 119 pregnant women were cultured on Cysteine Leucine Electrolyte Deficiency media (CLED) and sub-cultured on Mueller Hinton media. Gram staining was used to identify the isolated bacteria and Indole, Methyl-Red, Voges-Proskaur and Citrate assays were used for biochemical characterisation while Kirby Bauer disc technique was employed to determine drug susceptibility. The isolates were profiled for extended spectrum of beta lactamase genes (ESBL) using polymerase chain reaction methods and their biofilm formation activity. Data for antibiofilm was analyzed using a standard one-way ANOVA (Graph Pad Prism version 9.3) while that for drug resistance analyzed using one sample CHI square (SPSS version 25.0). Results were presented in bar graphs of ANOVA Dennett’s multiple comparison tests with significance level of 95% (P<0.05). Of the 119 urine samples, E. coli 28 (23.5%) was second in prevalence after S. aureus 40 (33.6%). All the E. coli isolates (28) showed resistance to Sulfamethoxazole 28(100%), Ceftriaxone 20 (71.42%), Amoxyclave 24 (85.75%) and were least resistant to Ofloxacin 6 (21.42%) and Gentamycin 4 (14.28%). The genotyped E. coli isolates contained 8 (42.1%) blaCTX-M, 6(31.6%), blaTEM and 5(26.31%) blaSHV ESBL genes. From the selected 12 high resistant isolates,8(66.7%) formed biofilms, a major cause of drug resistance. The study determined that E. coli as a key causative agent of UTIs, possesses ESBLs resistant genes and forms biofilms. It concludes that E. coli is the second most frequent causal agent of UTIs affecting pregnant women and the isolates have high antimicrobial resistance with major abilities to form biofilms even in the presence of common antibiotics that are currently in use. The study has provided a further understanding of biofilm detection in E. coli useful in the development of newer and more effective treatment.