Hsiao Chih-Yen, Lee Yi-Chien, Shyu Douglas J H, Su Che-Ping, Lin Man-Yi, Guo Nai-Yu, Chiang Cheng-Lun, Chen Yih-Yuan
Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.
Infect Drug Resist. 2024 Jun 15;17:2389-2399. doi: 10.2147/IDR.S458925. eCollection 2024.
The most common extraintestinal pathogen and infection site is uropathogenic (UPEC), which causes urinary tract infections (UTIs). UPEC is also a common pathogen in bloodstream infections; in severe cases, it can lead to death. Although host and bacterial virulence factors have been demonstrated to be associated with UTI pathogenesis, the role of the related contributing factors in UTI and urinary source bacteremia is not yet fully understood. This study aimed to compare and analyze the factors contributing to urinary bacteremia in patients with UTI.
A total of 171 strains collected from patients with UTI and urinary source bacteremia at Chiayi Christian Hospital were used. Phylogenetic groups and virulence factors were determined using PCR. Drug resistance patterns were determined using the disk diffusion assay.
Previous studies have demonstrated that fimbriae and papGII may be associated with first-step infections and severe UTIs, respectively. As expected, highly virulent strains (belonging to the phylogenetic B2 and D groups) were dominant in the bacteremic UTI (90%) and UTI (86.27%) groups. However, our results showed that the UTI group had a significantly higher prevalence of (belonging to the S and FIC fimbriae) than the bacteremic UTI group (29.4% vs 12.5%; p=0.008). In the bacteremic group, we found that / was only detected in highly virulent strains. The bacteremic UTI group had a significantly higher prevalence of GII (belonging to P fimbriae) than the UTI group (55.8% vs 37.3%; p=0.026). In addition, the P fimbriae gene cluster, including , and , was predominant in highly virulent strains. Notably, our results show that multidrug-resistant (MDR) strains were significantly less virulent than non MDR strains.
Taken together, our results provide insights into the contributing factors in patients with UTI and urinary bacteremia.
最常见的肠外病原体及感染部位是尿路致病性大肠杆菌（UPEC），它可引发尿路感染（UTI）。UPEC也是血流感染中的常见病原体；在严重情况下，可导致死亡。尽管宿主和细菌毒力因子已被证明与UTI发病机制有关，但相关促成因素在UTI和尿源性菌血症中的作用尚未完全明确。本研究旨在比较和分析导致UTI患者发生尿源性菌血症的因素。
使用从嘉义基督教医院UTI和尿源性菌血症患者中收集的共171株菌株。采用聚合酶链反应（PCR）确定系统发育群和毒力因子。使用纸片扩散法确定耐药模式。
先前的研究表明，菌毛和PapGII可能分别与初始感染和严重UTI有关。正如预期的那样，高毒力菌株（属于系统发育B2和D组）在菌血症性UTI组（90%）和UTI组（86.27%）中占主导地位。然而，我们的结果显示，UTI组中（属于S和FIC菌毛）的患病率显著高于菌血症性UTI组（29.4%对12.5%；p = 0.008）。在菌血症组中，我们发现/仅在高毒力菌株中检测到。菌血症性UTI组中GII（属于P菌毛）的患病率显著高于UTI组（55.8%对37.3%；p = 0.026）。此外，包括、和在内的P菌毛基因簇在高毒力菌株中占主导地位。值得注意的是,我们的结果表明多重耐药（MDR）菌株的毒力明显低于非MDR菌株。
综上所述，我们的结果为UTI和尿源性菌血症患者的促成因素提供了见解。
