Prevalence and antimicrobial resistance of shiga toxin-producing Escherichia coli and enteropathogenic Escherichia coli isolated from patients with acute diarrhea
AbstractBackground and Objectives: Diarrheal disease is still a major health problem in developing countries, where it is considered as one of the leading causes of morbidity and mortality especially in children. Escherichia coli is one of the important enteropathogenic bacteria which causes diarrhea in people. The aim of this study was to investigate the prevalence and antimicrobial resistance of shiga toxin–producing E. coli (STEC), Enterohaemorrhagic E. coli (EHEC), and Enteropathogenic E. coli (EPEC) in fecal samples collected from patients with acute diarrhea in a number of Iranian provinces.Materials and Methods: A total of 102 strains of E. coli were isolated from fecal samples collected from patients with acute diarrhea using microbiological phenotypic tests. The antibiotic susceptibility pattern of all isolates was determined by the disk agar diffusion (DAD) method. The presence of eae, bfp, stx1, sts2 and EAF genes in the isolates was investigated by PCR. The results were analyzed by SPSS; version 17.0 software.Results: Out of 102 E. coli isolates screened for specific genes, 52 strains of E. coli were identified to harbor STEC 26 (50%), EPEC 13 (25%) and EHEC 13 (25%). Greatest resistance was observed to amoxicillin and ampicillin 40 (76.9%), and most sensitivity to imipenem 52 (100%) and gentamicin 40 (76.9%). We also found that 80.77% of diarrheic E. coli isolates were multidrug resistant (MDR).Conclusion: The results showed that E. coli is one of the major causes of diarrhea and is highly resistant to commonly used antibiotics; therefore, officials must pay great attention to this issue in order to increase the health of the community.
Badouei MA, Lotfollahzadeh S, Arman M, Haddadi M. Prevalence and resistance profiles of Enteropathogenic and Shiga toxin-producing Escherichia coli in diarrheic calves in Mashhad and Garmsar districts, Iran. Avicenna J Clin Microb Infect 2014;1(3):e22802.
Haghi F, Zeighami H, Hajiahmadi F, Khoshvaght H, Bayat M. Frequency and antimicrobial resistance of diarrhoeagenic Escherichia coli from young children in Iran. J Med Microbiol 2014;63:427-432.
Velayati AA, Ghazi Saidi K, Taravati M. A study of Salmonella, Shigella and enteropathogenic Escherichia coli serotypes in acute gastroenteritis children under the age of five. Med J Islam Repub Iran 1987;1:22-31.
Abbasi P, Kargar M, Doosti A, Mardaneh J, Ghorbani-Dalini S, Dehyadegari MA. Characterization of Shiga-toxin producing E. coli (STEC) and enteropathogenic E. coli (EPEC) using multiplex Real-Time PCR assays for stx1, stx2, eaeA. Iran J Microbiol 2014;6:169-174.
Osawa K, Raharjo D, Wasito EB, Harijono S, Shigemura K, Osawa R, et al. Frequency of diarrheagenic Escherichia coli among children in Surabaya, Indonesia. Jpn J Infect Dis 2013;66:446-448.
Nweze E. Virulence properties of diarrheagenic E. coli and etiology of diarrhea in infants, young children and other age groups in southeast, Nigeria. Am-Euras J Sci Res 2009;4:173-179.
Aly ME, Hanora A, Essam TM, Amin MA. Genotypic detection of Enterohaemoragic E. coli (EHEC) among diarrheagenic patients in Egypt. Int J Microbiol Res 2014;5:61-64.
Jerse AE, Yu J, Tall BD, Kaper JB. A genetic locus of enteropathogenic Escherichia coli necessary for the production of attaching and effacing lesions on tissue culture cells. Proc Natl Acad Sci U S A 1990;87:7839-7843.
Bakhshi B, Fallahzad S, Pourshafie MR. The occurrence of atypical enteropathogenic Escherichia coli strains among children with diarrhea in Iran. J Infect Chemother 2013;19:615-620.
Nataro JP, Kaper JB. Diarrheagenic Escherichia coli. Clin Microbiol Rev 1998;11:142-201.
Kaper JB, Nataro JP, Mobley HL. Pathogenic Escherichia coli. Nat Rev Microbiol 2004;2:123-140.
Aslani MM, Alikhani MY, Zavari A, Yousefi R, Zamani AR. Characterization of enteroaggregative Escherichia coli (EAEC) clinical isolates and their antibiotic resistance pattern. Int J Infect Dis 2011;15(2):e136-139.
Jafari F, Hamidian M, Rezadehbashi M, Doyle M, Salmanzadeh-ahrabi S, Derakhshan F, et al. Prevalence and antimicrobial resistance of diarrheagenic Escherichia coli and Shigella species associated with acute diarrhea in Tehran, Iran. Can J Infect Dis Med Microbiol 2009;20(3):e56-62.
Bardbari AM, Arabestani MR, Karami M, Keramat F, Aghazadeh H, Alikhani MY, Bagheri KP. Highly synergistic activity of melittin with imipenem and colistin in biofilm inhibition against multidrug-resistant strong biofilm producer strains of Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis 2018;37:443-454.
Alikhani MY, Mirsalehian A, Fatollahzadeh B, Pourshafie MR, Aslani MM. Prevalence of enteropathogenic and Shiga toxin-producing Escherichia coli among children with and without diarrhoea in Iran. J Health Popul Nutr 2007:25;88-93.
Alikhani MY, Mirsalehian A, Aslani MM. Detection of typical and atypical enteropathogenic Escherichia coli (EPEC) in Iranian children with and without diarrhoea. J Med Microbiol 2006;55:1159-1163.
Burnens A, Boss P, Ørskov F, Ørskov I, Schaad U, Müller F, et al. Occurrence and phenotypic properties of verotoxin producing Escherichia coli in sporadic cases of gastroenteritis. Eur J Clin Microbiol Infect Dis 1992;11:631-634.
Desmarchelier PM. Enterohemorrhagic Escherichia coli—the Australian perspective. J Food Prot 1997;60:1447-1450.
Blanco J, Blanco M, Alonso M, Mora A, Dahbi G, Coira M, et al. Serotypes, virulence genes, and intimin types of Shiga toxin (verotoxin)-producing Escherichia coli isolates from human patients: prevalence in Lugo, Spain, from 1992 through 1999. J Clin Microbiol 2004;42:311-319.
Kehl SC. Role of the laboratory in the diagnosis of enterohemorrhagic Escherichia coli infections. J Clin Microbiol 2002;40:2711-2715.
Mathusa EC, Chen Y, Enache E, Hontz L. Non-O157 Shiga toxin–producing Escherichia coli in foods. J Food Prot 2010;73:1721-1736.
Bokete T, OCallahan C, Clausen C, Tang N, Tran N, Moseley S. Shiga-like toxin-producing Escherichia coli in Seattle children: A prospective study. Gastroenterology 1993;105:1724-1731.
Güney C, Aydogan H, Saracli MA, Basustaoglu A, Doganci L. No isolation of Escherichia coli O157: H7 strains from faecal specimens of Turkish children with acute gastroenteritis. J Health Popul Nutr 2001;19:336-337.
Vilchez S, Reyes D, Paniagua M, Bucardo F, Möllby R, Weintraub A. Prevalence of diarrhoeagenic Escherichia coli in children from Leon, Nicaragua. J Med Microbiol 2009;58:630-637.
Nguyen TV, Le Van P, Le Huy C, Gia KN, Weintraub A. Etiology and epidemiology of diarrhea in children in Hanoi, Vietnam. Int J Infect Dis 2006;10:298-308.
Pourakbari B, Heydari H, Mahmoudi S, Sabouni F, Teymuri M, Ferdosian F, et al. Diarrhoeagenic E. coli pathotypes in children with and without diarrhoea in an Iranian referral paediatrics centre. East Mediterr Health J 2013;19:617-621.
Salmanzadeh-Ahrabi S, Habibi E, Jaafari F, Zali M-R. Molecular epidemiology of Escherichia coli diarrhoea in children in Tehran. Ann Trop Paediatr 2005;25:35-39.
Nweze E. Aetiology of diarrhoea and virulence properties of diarrhoeagenic Escherichia coli among patients and healthy subjects in southeast Nigeria. J Health Popul Nutr 2010;28:245-252.
Dormanesh B, Siroosbakhat S, Goudarzi PK, Afsharkhas L. Shiga toxigenic Escherichia coli in Iranian pediatric patients with and without diarrhea: O-serogroups, virulence factors and antimicrobial resistance properties. Iran Red Crescent Med J 2015;17(10):e29706.
Jafari A, Aslani M, Bouzari S. Escherichia coli: a brief review of diarrheagenic pathotypes and their role in diarrheal diseases in Iran. Iran J Microbiol 2012;4:102-117.
Ishii S, Meyer KP, Sadowsky MJ. Relationship between phylogenetic groups, genotypic clusters, and virulence gene profiles of Escherichia coli strains from diverse human and animal sources. Appl Environ Microbiol 2007;73:5703-5710.
Trabulsi LR, Keller R, Gomes TAT. Typical and atypical enteropathogenic Escherichia coli. Emerg Infect Dis 2002;8:508-513.
Strockbine NA, Faruque SM, Kay BA, Haider K, Alam K, Alam A, et al. DNA probe analysis of diarrhoeagenic Escherichia coli: detection of EAF-positive isolates of traditional enteropathogenic E. coli serotypes among Bangladeshi paediatric diarrhoea patients. Mol Cell Probes 1992;6:93-99.
Badouei MA, Jajarmi M, Mirsalehian A. Virulence profiling and genetic relatedness of Shiga toxin-producing Escherichia coli isolated from humans and ruminants. Comp Immunol Microbiol Infect Dis 2015;38:15-20.
Franzolin MR, Alves RCB, Keller R, Gomes TAT, Beutin L, Barreto ML. Prevalence of diarrheagenic Escherichia coli in children with diarrhea in Salvador, Bahia, Brazil. Mem Inst Oswaldo Cruz 2005;100:359-363.
Momtaz H, Dehkordi FS, Hosseini MJ, Sarshar M, Heidari M. Serogroups, virulence genes and antibiotic resistance in Shiga toxin-producing Escherichia coli isolated from diarrheic and non-diarrheic pediatric patients in Iran. Gut Pathog 2013;5:39.
Ochman H, Lawrence JG, Groisman EA. Lateral gene transfer and the nature of bacterial innovation. Nature 2000;405:299-304.
Ahmed AA, Osman H, Mansour AM, Musa HA, Ahmed AB, Karrar Z, et al. Antimicrobial agent resistance in bacterial isolates from patients with diarrhea and urinary tract infection in the Sudan. Am J Trop Med Hyg 2000;63:259-263.
Al-Hussaini M, Saadabi A, Abdallah RM. Occurrence of multiple antibiotic resistances in Escherichia coli isolated from children of diarrheal symptoms. Int J Sci Res 2014;3:12-17.
Fazeli H, Salehi R. Antibiotic resistance pattern in Shiga toxin-producing Escherichia coli isolated from diarrheal patients in Al-zahra Hospital, Isfahan, Iran. Res Pharm Sci 2008;2:29-33.
Bouzari S, Jafari A, Zarepoor M. Distribution of genes encoding toxins and antibiotic resistance patterns in diarrhoeagenic Escherichia coli isolates in Tehran. East Mediterr Health J 2007;13:287-293.
Alikhani MY, Hashemi SH, Aslani MM, Farajnia S. Prevalence and antibiotic resistance patterns of diarrheagenic Escherichia coli isolated from adolescents and adults in Hamedan, Western Iran. Iran J Microbiol 2013;5:42-47.
Oberhelman RA, Laborde D, Mera R, Starszak E, Saunders P, Mirza A. Colonization with enteroadherent, enterotoxigenic and enterohemorrhagic Escherichia coli among day-care center attendees in New Orleans, Louisiana. Pediatr Infect Dis J 1998;17:1159-1162.
Samal SK, Khuntia HK, Nanda PK, Satapathy CS, Nayak SR, Sarangi AK. Incidence of bacterial enteropathogens among hospitalized diarrhea patients from Orissa, India. Jpn J Infect Dis 2008;61:350-355.