Belmont Cheyenne, Inamdar Pushkar, Shariff-Marco Salma, Gul Amina, Huang Alison J, Chambers Henry F, Raphael Eva
University of California, San Francisco.
Khyber Medical College.
Res Sq. 2025 May 7:rs.3.rs-6350015. doi: 10.21203/rs.3.rs-6350015/v1.
Antimicrobial resistance (AMR) is a major public health concern, especially in the clinical management of urinary tract infections (UTIs). While use of antimicrobial agents selects for AMR bacterial strains, it remains unclear if this factor alone drives the prevalence of UTIs caused by AMR uropathogenic (UPEC) in community settings. Local prevalence of AMR UTIs may be largely influenced by spatial clusters of already-resistant sequence types within a community rather than by the initial selection of resistant strains by antimicrobial agents. The goal of this study is to examine geospatial clustering of UTI by common AMR UPEC ST lineages.
We collected 551 UPEC isolates from patients receiving care in a San Francisco public healthcare system from April to September 2019. Isolates underwent multiplex PCR for rapid identification of pandemic UPEC STs (ST69, ST73, ST95, ST131) and were linked with electronic health records data. We conducted Global Moran's I and Local Moran's I to detect spatial clusters of each pandemic ST lineage.
Forty five percent of UPEC isolates (N = 247) were identified as pandemic ST lineages. ST131 comprised 72 (29%) of the pandemic ST lineages and contributed the most multidrug resistant isolates (resistant to ≥ 3 classes of antibiotics) (N = 29). Spatial clusters of ST95, ST131 and ST69 (p < 0.001, p < 0.001, p = 0.008, respectively) were identified.
We found spatial clusters of community-onset bacteriuria caused by predominant ST lineages, suggesting common-source outbreaks. This novel approach may inform future surveillance efforts to reduce community transmission of AMR UPEC and provides the basis for future investigations of environmental risk factors for AMR UTI.
抗菌药物耐药性（AMR）是一个重大的公共卫生问题，尤其是在尿路感染（UTI）的临床管理中。虽然使用抗菌药物会筛选出具有AMR的细菌菌株，但目前尚不清楚仅这一因素是否会导致社区环境中由AMR尿路致病性大肠杆菌（UPEC）引起的UTI患病率上升。AMR UTI的局部患病率可能在很大程度上受到社区内已耐药序列类型的空间聚集的影响，而不是抗菌药物对耐药菌株的初始筛选。本研究的目的是检查常见AMR UPEC ST谱系引起的UTI的地理空间聚集情况。
我们收集了2019年4月至9月在旧金山公共医疗系统接受治疗的患者的551株UPEC分离株。对分离株进行多重PCR，以快速鉴定大流行的UPEC STs（ST69、ST73、ST95、ST131），并将其与电子健康记录数据相关联。我们进行了全局莫兰指数（Global Moran's I）和局部莫兰指数（Local Moran's I）检测每个大流行ST谱系的空间聚集情况。
45%的UPEC分离株（N = 247）被鉴定为大流行ST谱系。ST131占大流行ST谱系的72株（29%），并且贡献了最多的多重耐药分离株（对≥3类抗生素耐药）（N = 29）。鉴定出了ST95、ST131和ST69的空间聚集（p分别<0.001、<0.001、= 0.008）。
我们发现了由主要ST谱系引起的社区发病菌尿的空间聚集，提示存在共同来源的暴发。这种新方法可能为未来减少AMR UPEC社区传播的监测工作提供信息，并为未来调查AMR UTI的环境风险因素提供基础。
