MULTIDRUG RESISTANT ESCHERICHIA COLI CAUSING URINARY TRACT INFECTIONS IN HEALTHY YOUNG WOMEN IN ISRAEL

Background: Urinary tract infections (UTI) are among the commonest infections inflicting young women. The major pathogen causing community-acquired UTI is Uropathogenic Escherichia coli (UPEC). Due to a substantial global increase in antibiotic-resistance and in the face of the endemic status in Israel, we aimed to characterize UPEC-related community-acquired UTI in healthy women.

Methods: Ampicillin-resistant E. coli isolates recovered from positive urine cultures were collected prospectively (6-month) from healthy young women (

Results: 668 UPEC-isolates were identified during the study period. Resistance rate for ampicillin was 49% and ESBL-production 4%. Ampicillin-resistant isolates showed diverse antibiograms, whereas all ESBL-producers were multidrug-resistant with resistance rates of 67%, 64% and 33% to ciprofloxacin, trimethoprim-sulphamethoxasole and gentamicin, respectively. Isolates were sensitive to carbapenems and amikacin. Phylotyping of all ampicillin-resistant UPEC isolates revealed high diversity with the majority (55%) belonging to highly-virulent phylogroups- B2 (38%) and D (17%), and the remaining belonging to B1 (28%) and A (17%). 70% of the ESBL-producers belonged to the highly virulent B2 and D phylogroups, and the major ESBL-group they carried was CTX-M: 64% CTX-M-15, 18% CTX-M-14 and 18% other non-CTX-M genes. 45% of the ESBL-producing isolates belonged to the worldwide highly-virulent endemic UPEC strain-ST131.

Conclusions: High antibiotic resistance rates including ESBL-production were found among community- UPEC isolates in healthy women. Understanding the epidemiological, clinical and molecular epidemiology of these infections may assist in designing preventive measures to limit emergence and spread of resistant strains and optimize antibiotic therapy.