Resistance Profiles and Virulence Factors of Enteric Escherichia coli in Chronic Kidney Disease Patients at Laquintinie Hospital in Douala, Cameroon.

Abstract

Escherichia coli is commonly found in human feces and is the most prevalent resistant microorganism in patients with chronic kidney disease. Several studies demonstrated that virulence factors were a major cause of the emergence of pathogenic strains of E. coli. This study's objective was to determine the antibiotic resistance profile, detect virulence factors, and assess the prevalence of carriage of extended-spectrum beta-lactamase (ESBL) genes in fecal E. coli isolates obtained from chronic kidney disease patients. This research was carried out in Laquintinie Hospital of Douala between January 2022 and December 2023. In total, 458 patients with (n = 197) or without (n = 261) chronic kidney disease and suffering from gastroenteritis constituted the total population. E. coli isolates were obtained by using eosin methylene blue (EMB) agar and identified by the API 20E gallery system. The Kirby-Bauer method was used to determine the isolates' antibiotic resistance profile. The simplex polymerase chain reaction (PCR) served to detect virulence factors and resistance genes. It appeared that all antibiotics tested, except nalidixic acid, presented a significant resistance (p < 0.05) in chronic kidney disease patients contrasted to patients without chronic kidney disease. The antibiotic susceptibility testing revealed a high level of resistance to amoxicillin (94.5%), amoxicillin-clavulanic acid (79.5%), trimethoprim/sulfamethoxazole (69.9%), and ofloxacin (65.8%) in patients with chronic kidney disease. E. coli isolates showed (p < 0.001) a significantly high rate of multidrug resistance phenotype in chronic kidney disease patients (74.0%) as compared to patients without chronic kidney disease (35.7%). According to the virulence genes detected, the most prevalent pathotype of E. coli was the enteropathogenic E. coli (40.8%; n = 40), followed by enterotoxigenic E. coli (29.6%; n = 29) and shiga toxin-producing E. coli (29.6%; n = 29). The screening of resistance genes in pathotypes of E. coli has demonstrated that bla _TEM (76.5%; n = 75) and bla _CTX-M (75.5%; n = 74) were the more frequent ESBL resistance genes encountered. This study showed that a high rate of resistance, multidrug resistance, and a high frequency of enteropathogenic E. coli and ESBL resistance genes in E. coli were most often found in chronic kidney disease patients. This high level of enteric multidrug-resistant E. coli in chronic kidney disease patients exposes them to hazardous antibiotic treatment and serious public health issues.