Insights into the phylogenetic profile and virulence-associated genes of multidrug-resistant uropathogenic in North of Iran.

Objectives: Urinary tract infections caused by multidrug-resistant uropathogenic (UPEC) strains limit therapeutic options and pose a serious threat to global health. This study aimed to analyze the phylogenetic distribution and virulence genes of multidrug resistant (MDR) UPEC strains and their associated risk factors.

Methods: UPEC isolates were subjected to phylogenetic and virulence genotyping using conventional and multiplex polymerase chain reaction methods. Antimicrobial susceptibility patterns were determined using disk diffusion method.

Results: Among 105 UPEC isolates, phylogenetic group B2 was the most prevalent (42.7%), followed by unknown (21.3%), E (15.7%), B1 (13.5%), and D (6.7%) among MDR UPEC isolates. A high prevalence of virulence genes, including and (98.9%), (96.6%), (92.1%), (89.9%), and (86.5%), and (68.5%), and (67.4%), was observed across various phylogenetic groups of MDR UPEC isolates. Among MDR strains, the highest resistance rates were to ampicillin, ciprofloxacin, and sulfamethoxazole-trimethoprim. In contrast, the highest susceptibility, aside from carbapenems, was to fosfomycin, amikacin, cefoxitin, and nitrofurantoin. We identified that male gender may increase the risk of infection with MDR UPEC strains. The results of this study revealed that phylogenetic group B2 of UPEC isolates are associated with virulence-associated genes and antibiotic resistance more than other phylogenetic groups.

Conclusions: The findings support the potential of these genes as targets for vaccine development and highlight the necessity for continued regional research to address antibiotic resistance and improve urinary tract infection management in order to select appropriate treatments.