Virulence factors analysis and antibiotic resistance of uropathogenic Escherichia coli isolated from patients in northeast of Iran

2020 ◽  
Author(s):  
Mahdis Ghavidel ◽  
Tahere Gholamhosseini-Moghadam ◽  
Kimiya Nourian ◽  
Kiarash Ghazvini
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Virulence Genes ◽  
High Rate ◽  
Resistance Pattern ◽  
Antibiotics Resistance ◽  
Disk Diffusion Test ◽  
E Coli ◽  
Genes Encoding ◽  
Tract Infections

Background and Objectives: Escherichia coli is known to be the pathogen commonly isolated from those infected with uri- nary tract infections (UTIs). The aim of this study was to investigate the presence of E. coli virulence genes and antibiotics’ resistance pattern among clinical isolates in the Northeast of Iran. Relationships between virulence genes and antimicrobial resistances were studied as well. Materials and Methods: Three hundred isolates of E. coli were isolated from patients with UTIs that referred to Ghaem and Imam Reza hospitals (Mashhad, Iran) during August 2016 to February 2017. A multiplex PCR was employed to amplify the genes encoding pyelonephritis associated pili (pap), S-family adhesions (sfa), type1fimbriae (fimH) and aerobactin (aer). Disk diffusion test was performed to test the susceptibility of isolates to β-lactams, aminoglycosides, cephalosporins, quino- lone, fluoroquinolones, carbapenems and trimethoprim-sulfamethoxazole. Results: The PCR results identified the fimH in 78.4%, aer in 70.5%, sfa in 13.6% and the pap in 8.2% of isolates. The rates of antibiotic resistance of the isolates were as follows: 64.7% resistant to cephalosporins, 34% to trimethoprim-sul- famethoxazole, 31% to fluoroquinolones, 15.3% to aminoglycosides, 13.3% to β-lactams, 7.8% to quinolones and 4.4% to carbapenems. Significant relationships existed between pap and aer, pap and sfa, aer and fluoroquinolones also pap and cephalosporins. Conclusion: fimH and aer were found in > 50% of isolates suggesting the importance of both genes in UPEC. The majority of isolates had fimH as adhesion factor for colonization. Determining antibiotic resistance patterns in specific geographical areas is necessary for appropriate treatment of urinary tract infection. The high rate of resistance to cephalosporins is most likely due to incorrect drug administration

scholarly journals Detection of biofilm among uropathogenic Escherichia coli and its correlation with antibiotic resistance pattern

2019 ◽  
Vol 11 (01) ◽  
pp. 017-022 ◽  
Author(s):  
Rashmi M. Karigoudar ◽  
Mahesh H. Karigoudar ◽  
Sanjay M. Wavare ◽  
Smita S. Mangalgi
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Biofilm Formation ◽  
Agar Plate ◽  
Diffusion Method ◽  
Resistance Pattern ◽  
Susceptibility Pattern ◽  
Sensitivity Testing ◽  
E Coli ◽  
Tract Infections

Abstract BACKGROUND: Escherichia coli accounts for 70%–95% of urinary tract infections (UTIs). UTI is a serious health problem with respect to antibiotic resistance and biofilms formation being the prime cause for the antibiotic resistance. Biofilm can restrict the diffusion of substances and binding of antimicrobials. In this context, the present study is aimed to perform in vitro detection of biofilm formation among E. coli strains isolated from urine and to correlate their susceptibility pattern with biofilm formation. MATERIALS AND METHODS: A total of 100 E. coli strains isolated from patients suffering from UTI were included in the study. The identification of E. coli was performed by colony morphology, Gram staining, and standard biochemical tests. The detection of biofilm was carried out by Congo Red Agar (CRA) method, tube method (TM), and tissue culture plate (TCP) method. Antimicrobial sensitivity testing was performed by Kirby–Bauer disc diffusion method on Muller–Hinton agar plate. RESULTS: Of the 100 E. coli strains, 49 (49%) and 51 (51%) were from catheterized and noncatheterized patients, respectively. Biofilm production was positive by CRA, TM, and TCP method were 49 (49%), 55 (55%), and 69 (69%), respectively. Biofilm producers showed maximum resistance to co-trimoxazole (73.9%), gentamicin (94.2%), and imipenem (11.6%) when compared to nonbiofilm producers. Significant association was seen between resistance to antibiotic and biofilm formation with a P = 0.01 (<0.05). CONCLUSION: A greater understanding of biofilm detection in E. coli will help in the development of newer and more effective treatment. The detection of biofilm formation and antibiotic susceptibility pattern helps in choosing the correct antibiotic therapy.

Genetic Diversity and Antibiotic Resistance of Escherichia coli Isolates from Different Leafy Green Production Systems

2016 ◽  
Vol 79 (11) ◽  
pp. 1846-1853 ◽  
Author(s):  
MOSIMANEGAPE JONGMAN ◽  
LISE KORSTEN
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Irrigation Water ◽  
Virulence Genes ◽  
Production Systems ◽  
Fresh Produce ◽  
Health Concern ◽  
Small Scale ◽  
Disk Diffusion Test ◽  
E Coli

ABSTRACT Foodborne disease outbreaks linked to contaminated irrigation water and fresh produce are a public health concern. The presence of Escherichia coli isolates from irrigation water and leafy green vegetables in different food production systems (large commercial farms, small-scale farms, and homestead gardens) was investigated. The prevalence of antibiotic resistance and virulence in these isolates was further assessed, and links between water source and irrigated crops were identified using antimicrobial and genotypic analyses. Presumptive E. coli isolates were identified by matrix-assisted laser desorption ionization time-of-flight mass spectroscopy, and identities were confirmed by PCR using the uidA gene. Antimicrobial susceptibility was evaluated with the Kirby Bauer disk diffusion test; the presence of virulence genes was determined with enterobacterial repetitive intergenic consensus PCR assays. Of the 130 E. coli isolates from water (n =60) and leafy green vegetables (n =70), 19 (14.6%) were resistant to one antibiotic (tetracycline) and 92 (70.7%) were resistant to various antibiotics (including ampicillin, cefoxitin, and nalidixic acid). All E. coli isolates were susceptible to ceftriaxone and gentamicin. The virulence gene stx2 was detected in E. coli isolates from irrigation water (8 [13.3%] of 60 isolates) and cabbages (3 [7.5%] of 40), but the virulence genes eae and stx1 were not detected in any tested isolates from irrigation water and fresh produce samples. The prevalence of multidrug-resistant E. coli was lower in isolates from GLOBALG.A.P.-certified farms than in isolates from noncertified commercial and small-scale farms and homestead gardens. A link between the E. coli isolates from irrigation water sources and leafy green vegetables was established with phenotypic (antimicrobial) and genotypic (DNA fingerprinting) analyses. However, a link between virulence genes and the prevalence of antimicrobial resistance could not be established.

scholarly journals Identification of Quinolone and Colistin Resistance Genes in Escherichia Coli Strains Isolated from Mucosal Samples of Patients with Colorectal Cancer and Healthy Subjects

2020 ◽  
Vol 15 (1) ◽  
pp. 30-40
Author(s):  
Hassan Mahmoudi ◽  
Sima Ghiasvand ◽  
Omid Zarei ◽  
Hadi Hossainpour ◽  
Mohammad Y. Alikhani
Keyword(s):  
Colorectal Cancer ◽  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Cancer Patients ◽  
Resistance Genes ◽  
Healthy People ◽  
Disk Diffusion Test ◽  
E Coli ◽  
Genes Encoding ◽  
Colorectal Cancer Patients

Introduction: : Antibiotic resistance and extensive use of antibiotics are amongst the major causes of failure in antibiotic treatment. The purpose of this study was to investigate antibiotic resistance patterns and to identify resistance genes of quinolones and colistin in Escherichia coli. There are a very few patents on E. coli isolated from colorectal cancer. So, this study demonstrates that some bacteria resistant to ciprofloxacin have not resistance genes.Moreover, new patterns for E. coli are presented for isolates of patients with colorectal cancer. Materials and Methods: : Of the three healthy people, inflammatory bowel diseases (IBD) patients and colorectal cancer patients, 40 E. coli strains isolated after confirmation by biochemical and molecular methods. The susceptibility of isolates to antibiotics was investigated using disk diffusion test. After deoxyribonucleic acid (DNA) extraction, polymerase chain reaction (PCR) was used to identify genes encoding resistance to ciprofloxacin (qnr A, qnr B) and colistin (mcr-1). Results:: The results showed that E. coli isolates from colorectal cancer patients had the highest resistance to piperacillin (67.5%), ceftazidime (47.5%), and cefepime (42.5%). Also, E. coli strains isolated from IBD patients showed resistance to antibiotic ceftazidime 13%. More than 95% of E. coli strains isolated from healthy people were susceptible to antibiotics. Based on the results, 18 (15%) E. coli strains showed resistance to ciprofloxacin. The qnr A gene was detected in 61.11% isolates; however, qnr B was detected in 9 (50%) isolates. Isolates resistant to colistin were not observed. Conclusion: : These findings indicate increased resistance of E. coli to ciprofloxacin in comparison with prior studies. Further research in this field will increase our knowledge and more effective exposure to the antibiotic resistance of the pathogenic microorganisms.

scholarly journals Uropathogenic Escherichia coli in the Urine Samples of Iranian Dogs: Antimicrobial Resistance Pattern and Distribution of Antibiotic Resistance Genes

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Amirhossein Yousefi ◽  
Saam Torkan
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Antimicrobial Resistance ◽  
Resistance Genes ◽  
Antibiotic Resistance Genes ◽  
Urine Samples ◽  
Disk Diffusion ◽  
Resistance Pattern ◽  
E Coli ◽  
Tract Infections

Resistant uropathogenic Escherichia coli is the most common cause of urinary tract infections in dogs. The present research was done to study the prevalence rate and antimicrobial resistance properties of UPEC strains isolated from healthy dogs and those which suffered from UTIs. Four-hundred and fifty urine samples were collected and cultured. E. coli-positive strains were subjected to disk diffusion and PCR methods. Two-hundred out of 450 urine samples (44.4%) were positive for E. coli. Prevalence of E. coli in healthy and infected dogs was 28% and 65%, respectively. Female had the higher prevalence of E. coli (P=0.039). Marked seasonality was also observed (P=0.024). UPEC strains had the highest levels of resistance against gentamicin (95%), ampicillin (85%), amikacin (70%), amoxicillin (65%), and sulfamethoxazole-trimethoprim (65%). We found that 21.50% of UPEC strains had simultaneously resistance against more than 10 antibiotics. Aac(3)-IV (77%), CITM (52.5%), tetA (46.5%), and sul1 (40%) were the most commonly detected antibiotic resistance genes. Findings showed considerable levels of antimicrobial resistance among UPEC strains of Iranian dogs. Rapid identification of infected dogs and their treatment based on the results of disk diffusion can control the risk of UPEC strains.

scholarly journals Diverse Escherichia coli pathovars of phylogroups B2 and D isolated from animals in Tunisia

2017 ◽  
Vol 11 (07) ◽  
pp. 549-556 ◽  
Author(s):  
Hajer Kilani ◽  
Mohamed Salah Abbassi ◽  
Sana Ferjani ◽  
Rakia Ben Salem ◽  
Riadh Mansouri ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Polymerase Chain Reaction ◽  
Antibiotic Resistance ◽  
Virulence Genes ◽  
Chain Reaction ◽  
E Coli ◽  
Class 1 ◽  
Genes Encoding ◽  
Polymerase Chain ◽  
Relationship Of

Introduction: The virulent Escherichia coli strains responsible for extraintestinal infections were mainly belonged to B2 and D phylogroups. However, no past studies have determinate via the presence of virulence genes the frequency of E. coli pathovars recovered from animals housed in farms in Tunisia. The aims of this study were to investigate 26 E. coli isolated from healthy and diarrheic animals and to determinate via the presence of virulence genes the frequency of pathovars. Methodology: Twenty-six E. coli isolates of phylogroups B2 (n = 14), B22 (n = 9), B23 (n = 5), and D2 (n = 12) were characterized. Genes encoding virulence factors (fimH,eaeA,aggC,papC, papG allele III, hlyA, east1, cnf1, exhA,stx1, stx2, iutA, fyuA, ibeA,and ipaH), and antibiotic resistance as well as class 1 and 2 integrons were searched by polymerase chain reaction (PCR). The genetic relationship of isolates was done by PFGE. Results: According to the occurrence of specific genes the 26 isolates were classified as:9 EAEC, 2 EHEC, 4 UPEC, 3 EPEC/EHEC and 1 NTEC. Therefore, 2 Ex-PEC and 5 APEC were presented amongst our strains. Some isolates (12) were clonal and the remaining was unrelated. Conclusions: Higher diversity of pathovars which carried diverse combinations of virulence genes in healthy isolates. In addition, it seems that the infections were caused by different mechanisms.

scholarly journals Enteroaggregative Escherichia coli is associated with antibiotic resistance and urinary tract infection symptomatology

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11726
Author(s):  
Verónica I. Martínez-Santos ◽  
María Ruíz-Rosas ◽  
Arturo Ramirez- Peralta ◽  
Oscar Zaragoza García ◽  
Luis Armando Resendiz-Reyes ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract Infection ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Tract Infection ◽  
Virulence Genes ◽  
Clinical Isolates ◽  
E Coli ◽  
Ambulatory Patients ◽  
Tract Infections

Background Uropathogenic Escherichia coli (UPEC) is the causative agent of uncomplicated urinary tract infections (UTIs) in ambulatory patients. However, enteroaggregative E. coli (EAEC), an emergent bacterial pathogen that causes persistent diarrhoea, has recently been associated with UTIs. The aim of this study was to determine the frequency of EAEC virulence genes, antibiotic resistance, as well as biofilm production of UPEC isolates obtained from ambulatory patients with non-complicated UTIs that attended to the ISSSTE clinic in Chilpancingo, Guerrero, Mexico, and correlate these with the patients’ urinary tract infection symptomatology. Methods One hundred clinical isolates were obtained. The identification of clinical isolates, antimicrobial susceptibility testing, and extended spectrum beta-lactamases (ESBLs) production were performed using the Vitek automated system. Assignment of E. coli phylogenetic groups was performed using the quadruplex phylo-group assignment PCR assay. UPEC virulence genes (hlyA, fimH, papC, iutA, and cnf1) and EAEC virulence genes (aap, aggR, and aatA) were detected by multiple PCR. Results We found that 22% of the isolates carried the aggR gene and were classified as UPEC/EAEC. The main phylogenetic group was B2 (44.1% were UPEC and 77.27% UPEC/EAEC isolates, respectively). Over half of the UPEC/EAEC isolates (63.64%) were obtained from symptomatic patients, however the aatA gene was the only one found to be associated with the risk of developing pyelonephritis (OR = 5.15, p = 0.038). A total of 77.71% of the UPEC/EAEC isolates were ESBL producers and 90.91% multidrug-resistant (MDR). In conclusion, UPEC/EAEC isolates are more frequent in symptomatic patients and the aatA gene was associated with a higher risk of developing pyelonephritis, along with UPEC genes hlyA and cfn1. UPEC/EAEC isolates obtained from UTI showed ESBL production and MDR.

scholarly journals Antibiotic resistance pattern of Escherichia coli isolates from outpatients with urinary tract infections in Somalia

2020 ◽  
Vol 14 (03) ◽  
pp. 284-289 ◽  
Author(s):  
Malyun Adam Mohamed ◽  
Omar Abdifetah ◽  
Fatima Abdullahi Hussein ◽  
Sa’adia Abdullahi Karie
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Resistance Rate ◽  
Resistance Pattern ◽  
E Coli ◽  
Antibiotic Resistance Pattern ◽  
History Of ◽  
Tract Infections

Introduction: Several studies suggest increasing rates of antibiotic resistance among adult populations with Urinary tract infections (UTI). Escherichia coli (E. coli), is the predominant bacterium both in the community and in hospital environments causing uropathogenic infections. This study aimed to estimate the common uropathogen bacteria that cause UTI among outpatients as well as to determine the antibiotic resistance pattern of E. coli isolates among outpatients with UTI infections at Shaafi hospital, Mogadishu, Somalia. Methodology: A cross-sectional study was conducted at Shaafi Hospital, Mogadishu, Somalia. A total of 128 samples were collected from outpatients suspected of UTI and tested through bacteriological investigations and antimicrobial susceptibility tests following the Kirby-Bauer agar disc diffusion method. Results: E. coli was isolated in 34 (41%) out of the total 83 samples that showed growth followed by Staphylococcus aureus 22 (26.5%), Pseudomonas aeruginosa, 13 (15.7%), Klebsiella pneumoniae 8 (9.6 %) and Proteus spp. 6 (7.2%). E. coli was highly sensitive to nitrofurantoin, 29 (85.3%), and ciprofloxacin (n = 23, 67.6%), and had the highest resistance rate of ceftriaxone, 33 (97.1%). The odds of having UTI were higher in patients with a history of UTI (Odds ratio OR = 0.211, 95% confidence interval CI: 0.080, 0.553) and history of antibiotic use (OR = 0.322, 95% CI: 0.113, 0.917). Increased resistance rate of E. coli against cephalosporins could be due to its excessive use as empirical therapy. Conclusion: The study indicates that outpatients with UTI could be at high risk of antibiotic resistance, suggesting regular surveillance and monitoring of antibiotics.

scholarly journals Assessing the population dynamics of Escherichia coli in a metropolitan river after an extreme flood event

2016 ◽  
Vol 15 (2) ◽  
pp. 196-208 ◽  
Author(s):  
Nicole M. Masters ◽  
Aaron Wiegand ◽  
Jasmin M. Thompson ◽  
Tara L. Vollmerhausen ◽  
Eva Hatje ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Population Dynamics ◽  
Antibiotic Resistance ◽  
Virulence Genes ◽  
Wastewater Treatment Plants ◽  
Vero Cells ◽  
Flood Event ◽  
Typing Method ◽  
E Coli ◽  
Extreme Flood

We investigated Escherichia coli populations in a metropolitan river after an extreme flood event. Between nine and 15 of the 23 selected sites along the river were sampled fortnightly over three rounds. In all, 307 E. coli were typed using the PhP typing method and were grouped into common (C) or single (S) biochemical phenotypes (BPTs). A representative from each of the 31 identified C-BPTs was tested for 58 virulence genes (VGs) associated with intestinal and extra-intestinal E. coli, resistance to 22 antibiotics, production of biofilm and cytotoxicity to Vero cells. The number of E. coli in the first sampling round was significantly (P &lt; 0.01) higher than subsequent rounds, whereas the number of VGs was significantly (P &lt; 0.05) higher in isolates from the last sampling round when compared to previous rounds. Comparison of the C-BPTs with an existing database from wastewater treatment plants (WWTPs) in the same catchment showed that 40.6% of the river isolates were identical to the WWTP isolates. The relatively high number of VGs and antibiotic resistance among the C-BPTs suggests possessing and retaining these genes may provide niche advantages for those naturalised and/or persistent E. coli populations which may pose a health risk to the community.

scholarly journals Prevalence Of Extended Spectrum Beta-Lactamases (ESBLs)-Producing Escherichia Coli Isolated From UTI Patients Attending some Selected Hospitals In Minna, Nigeria

2021 ◽  
Vol 37 (2) ◽  
pp. 56-73
Author(s):  
F Iseghohi ◽  
J.C Igwe ◽  
M Galadima ◽  
A.F Kuta ◽  
A.M Abdullahi ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Multidrug Resistance ◽  
Urine Samples ◽  
Antibiotics Resistance ◽  
Healthy Individuals ◽  
Beta Lactamases ◽  
E Coli ◽  
Extended Spectrum ◽  
Extended Spectrum Beta Lactamases ◽  
Tract Infections

Globally, urinary tract infections are one of the most common infections in need of urgent clinical attention. The prevalence of extended spectrum beta-lactamases (ESBL)- producing Escherichia coli isolated from urine samples of some UTI patients and s of apparently healthy individuals in Minna, Nigeria, is investigated. Standard microbiological techniques were used to conduct this study. A total of 170 catch midstream urine samples submitted to the Medical Microbiology Laboratories of 4 different hospitals (and samples from healthy individuals) were randomly collected for 5 months and examined for microbial growths. Female patients (65.9%) submitted more urine samples for UTI test than their male counterpart (34.1%). The age ranges of 21 -30 (26.5%) and 31 - 40 (25.3%) had the highest percentages of infection rate while those within the ages 1- 10 (3.5%) and ≥ 71 (2.3%) were the least infected. This study observed a prevalence of 23.5% of E. coli in Minna metropolis and a significant number (30%) of healthy individuals (HI) was observed to harbor the E. coli in their urine. The isolates were highly susceptible to Gentamicin (65%), Ofloxacin (65%), Tetracycline (62.5%), Cotrimoxazole (62.5%), and Streptomycin (57.5%). Mildly susceptible to Pefloxacin (37.5%), Chloramphenicol (37.5%), and Ciprofloxacin (35%). There were significant resistance to most of the beta-lactames tested [Cefuroxime (80%), Amoxicillin (42.5%), Augmentin (40), Cefotaxime (20%) and Ceftaxidime (7.5%)]. Two of the isolates were resistant to all the 13 antibiotics tested; 70% (28) of the isolates had multiple antibiotics resistance index (MARI) ≥0.3. Multidrug resistance was expressed in 37.5% of the isolates tested. The study showed a vast resistant pool in the environment. Only 25% of the E. coli isolated from the urine samples produced beta-lactamases phenotypically, most of which expressed resistance to more than 5 of the antibiotics tested and had MARI of ≥ 0.5. Further evaluation showed that 25% (10/40) of the E. coli isolated from the UTI patients in Minna, Nigeria, were ESBL- producers and could harbor one or two of the genes. TEM gene was expressed in 70% (7) of the isolates that produced ESBL phenotypically, 60% 6) harbored CTXM gene, 20% (2) had the OXA gene while none of the bacteria harbored the SHV gene. The study established a 5.9% ESBL prevalence among the E. coli isolated from UTI in the environment studied. This study established that E. coli is one of the prevalent bacteri urea majorly isolated from UTI patients in Minna. The prevalent E. coli are multidrug resistant and could harbor more than one ESBL gene . keywords: Escherichia coli, Minna, UTI, ESBL, Multidrug resistance

scholarly journals The population genomics of increased virulence and antibiotic resistance in human commensal Escherichia coli over 30 years in France

2021 ◽  
Author(s):  
Julie Marin ◽  
Olivier Clermont ◽  
Guilhem Royer ◽  
Melanie Mercier-Darty ◽  
Jean-Winoc Decousser ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
High Risk ◽  
Virulence Genes ◽  
Population Genomics ◽  
E Coli ◽  
O Antigen ◽  
Similar Region ◽  
Intestinal Infections ◽  
Evolution Of Virulence

Escherichia coli is a commensal species of the lower intestine, but also a major pathogen causing intestinal and extra-intestinal infections. Most studies on genomic evolution of E. coli used isolates from infections, and/or focused on antibiotic resistance, but neglected the evolution of virulence. Here instead, we whole-genome sequenced a collection of 436 E. coli isolated from fecal samples of healthy adult volunteers in France between 1980 and 2010. These isolates were distributed among 159 sequence types (STs), the five most frequent being ST10 (15.6%), ST73 (5.5%) and ST95 (4.8%), ST69 (3.7%) and ST59 (3.7%), and 230 O:H serotypes. ST and serotype diversity increased over time. Comparison with 912 E. coli bacteremia isolates from similar region and time showed a greater diversity in commensal isolates. The O1, O2, O6 and O25-groups used in bioconjugate O-antigen vaccine were found in only 63% of the four main STs associated with a high risk of bacteremia (ST69, ST73, ST95 and ST131). In commensals, STs associated with a high risk of bacteremia increased in frequency. Both extra-intestinal virulence-associated genes and resistance to antibiotics increased in frequency. Evolution of virulence genes was driven by both clonal expansion of STs with more virulence genes, and increases in frequency within STs, whereas the evolution of resistance was dominated by increases in frequency within STs. This study provides a unique picture of the phylogenomic evolution of E. coli in its human commensal habitat over a 30-year period and suggests that the efficacy of O-antigen vaccines would be threatened by serotype replacement.

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