Uropathogenic Escherichia coli (UPEC) is the main etiological agent behind community-acquired and hospital-acquired urinary tract infections (UTIs), which are among the most prevalent human infections. The management of UPEC infections is becoming increasingly difficult owing to multi-drug resistance, biofilm formation, and the possession of an extensive virulence arsenal. This study aims to characterize UPEC isolates in Tanta, Egypt, with regard to their antimicrobial resistance, phylogenetic profile, biofilm formation, and virulence, as well as the potential associations among these factors. One hundred UPEC isolates were obtained from UTI patients in Tanta, Egypt. Antimicrobial susceptibility was assessed using the Kirby-Bauer method. Extended-spectrum β-lactamases (ESBLs) production was screened using the double disk synergy test and confirmed with PCR. Biofilm formation was evaluated using the microtiter-plate assay and microscopy-based techniques. The phylogenetic groups of the isolates were determined. The hemolytic activity, motility, siderophore production, and serum resistance of the isolates were also evaluated. The clonal relatedness of the isolates was assessed using ERIC-PCR. Isolates displayed elevated resistance to cephalosporins (90–43%), sulfamethoxazole-trimethoprim (63%), and ciprofloxacin (53%). Ninety percent of the isolates were multidrug-resistant (MDR)/ extensively drug-resistant (XDR) and 67% produced ESBLs. Notably, there was an inverse correlation between biofilm formation and antimicrobial resistance, and 31%, 29%, 32%, and 8% of the isolates were strong, moderate, weak, and non-biofilm producers, respectively. Beta-hemolysis, motility, siderophore production, and serum resistance were detected in 64%, 84%, 65%, and 11% of the isolates, respectively. Siderophore production was correlated to resistance to multiple antibiotics, while hemolysis was more prevalent in susceptible isolates and associated with stronger biofilms. Phylogroups B2 and D predominated, with lower resistance and stronger biofilms in group B2. ERIC-PCR revealed considerable diversity among the isolates. This research highlights the dissemination of resistance in UPEC in Tanta, Egypt. The evident correlation between biofilm and resistance suggests a resistance cost on bacterial cells; and that isolates with lower resistance may rely on biofilms to enhance their survival. This emphasizes the importance of considering biofilm formation ability during the treatment of UPEC infections to avoid therapeutic failure and/or infection recurrence.

中文翻译：

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埃及医院泌尿道致病性大肠杆菌抗菌素耐药性、生物膜形成和毒力决定因素之间的相关性

尿路致病性大肠杆菌 (UPEC) 是社区获得性和医院获得性尿路感染 (UTI) 的主要病原体，这些感染属于最常见的人类感染之一。由于多重耐药性、生物膜形成和拥有广泛的毒力库，UPEC 感染的管理变得越来越困难。本研究旨在表征埃及坦塔的 UPEC 分离株的抗菌耐药性、系统发育特征、生物膜形成和毒力，以及这些因素之间的潜在关联。从埃及坦塔的尿路感染患者中获得了 100 份 UPEC 分离株。使用 Kirby-Bauer 方法评估抗菌药物敏感性。使用双盘协同试验筛选超广谱 β-内酰胺酶 (ESBL) 的产生，并通过 PCR 进行确认。使用微量滴定板测定和基于显微镜的技术评估生物膜形成。确定了分离株的系统发育群。还评估了分离株的溶血活性、运动性、铁载体产生和血清抗性。使用 ERIC-PCR 评估分离株的克隆相关性。分离株对头孢菌素 (90-43%)、磺胺甲恶唑-甲氧苄啶 (63%) 和环丙沙星 (53%) 显示出较高的耐药性。90% 的分离株具有多重耐药性 (MDR)/广泛耐药性 (XDR)，67% 的分离株产生 ESBL。值得注意的是，生物膜形成与抗菌素耐药性之间存在负相关，分别有 31%、29%、32% 和 8% 的分离株具有强、中、弱和非生物膜产生能力。分别在 64%、84%、65% 和 11% 的分离株中检测到 β 溶血、运动性、铁载体产生和血清抗性。铁载体的产生与对多种抗生素的耐药性相关，而溶血在易感菌株中更为普遍，并与更强的生物膜相关。系统群 B2 和 D 占主导地位，B2 群的抗性较低，生物膜较强。ERIC-PCR 显示分离株之间存在相当大的多样性。这项研究强调了埃及坦塔 UPEC 中阻力的传播。生物膜和耐药性之间的明显相关性表明细菌细胞的耐药性成本；耐药性较低的分离株可能依靠生物膜来提高其生存率。这强调了在治疗 UPEC 感染期间考虑生物膜形成能力的重要性，以避免治疗失败和/或感染复发。