Kerbala Journal of Medicine

Abstract

background: Escherichia coli is a frequent cause of urinary tract infections, however, its identity as pathogen in the cervico-vaginal area is required to be ascertained. In addition, source (s) for E.coli colonzing female vagina is needed to be confirmed, whether its fecal contamination or from urinary tract.
Aim of the Study: To perform a comparative analysis of the E. coli clinical isolates from vagina versus those from urine in terms of molecular phylogeny, molecular determinants of virulence and antimicrobial susceptibility.
Materials and methods: A total of 60 E. coli strains from high vaginal swabs (n=30) and urine (n=30) were analyzed. Identification of phylogenetic groups and detection of adhesive genes were conducted by 2 different multiplex PCR systems. Antibiograms for all isolates were performed by Kirby-Bauer method.
Results and Discussion: Majority of vaginal E coli (VEC) isolates were belong to B2 phylogenetic group (n=20, 66.7%), whereas, majority of uro-pathogenic E. coli (UPEC) isolates were distributed between two phylogenetic groups, namely B2 12 (40%) and D 11 (36.7%). Therefore, most of the strains from both vagina and urine are belonging to pathogenic phylogenetic groups; however, they differ in prevalence of the groups. The pap gene has a higher frequency among UPEC (n= 13, 43.3%) than in VEC isolates (n=7, 23.3%). Similarly, sfa gene has a higher frequency in VEC isolates (n= 20, 66.7%) than in UPEC isolates 11 (36.4%). Consequently, adhesion genes playing roles in vaginal colonization may differ from that in urinary tract .VEC strains where highly susceptible to ciprofloxacin (100%) followed by nitrofurantoin (73.3%) and nalidixic acid (70%). Whereas UPEC strains were highly susceptible to nitrofurantoin (100%) followed by nalidixic acid. Thus, it seems that cirpofloxacin is appropriate for empirical therapy in vaginal infections, whereas nitrofurantoin is more appropriate for empirical therapy in UTI.
Conclusion: Strains isolated from high vaginal swabs differ from strains isolated from urine in the prevalence of phyelogenetic groups andmolecular determinants of virulence as well as in antibiograms.