Genetic relatedness of the Enterococcus faecalis isolates in stool and urine samples of patients with community-acquired
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Gut Pathogens Open Access
RESEARCH
Genetic relatedness of the Enterococcus faecalis isolates in stool and urine samples of patients with community‑acquired urinary tract infection Zohreh Ghalavand4, Masoud Alebouyeh2, Kiandokht Ghanati3, Leila Azimi2 and Marjan Rashidan1,4*
Abstract Background: Community-acquired urinary tract infection (CA-UTI) could be caused by endogenous or exogenous routes. To show this relationship, we investigated molecular fingerprints and genotypes of paired Enterococcus faecalis isolated from the urine of symptomatic patients and their fecal samples. Results: Out of the studied patients, 63 pairs of E. faecalis isolates were obtained simultaneously from their urine and feces samples. All the strains were sensitive to vancomycin, linezolid, nitrofurantoin, and daptomycin (MIC value: ≤ 4 µg/ml), while resistance to tetracycline (urine: 88.9%; stool: 76.2%) and minocycline (urine: 87.3%, stool: 71.4%) was detected in most of them. The most common detected virulence genes were included efbA, ace, and gelE. RAPD-PCR and PFGE analyses showed the same patterns of molecular fingerprints between paired of the isolates in 26.9% and 15.8% of the patients, respectively. Conclusions: Similarity of E. faecalis strains between the urine and feces samples confirmed the occurrence of endogenous infection via contamination with colonized bacteria in the intestinal tract. Carriage of a complete virulence genotype in the responsible strains was statistically in correlation with endogenous UTI, which shows their possible involvement in pathogenicity of uropathogenic E. faecalis strains. Keywords: Enterococcus faecalis, Virulence, Urinary tract infection, Fecal microbiota, Antimicrobial resistance Background Urinary tract infections (UTIs) are the most common bacterial infections both in the community and hospital settings at all age groups. Although uropathogenic Escherichia coli is the most common cause of community-acquired urinary tract infections in humans [1], Enterococcus species, especially Enterococcus faecalis (E. faecalis), are considered as the second most important cause of UTI among uropathogenic bacteria [2, 3]. *Correspondence: [email protected] 1 School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran Full list of author information is available at the end of the article
E. faecalis can also cause surgical wound infection, bacteremia, endocarditis, neonatal sepsis, and meningitis [4]. E. faecalis is predominantly inhabitant of the human gastrointestinal tract, where they form part of the normal intestinal flora in approximate amounts of 1 08 colonies per gram of feces [5]. This rate of colonization could predispose our urinary tract to recurrent infections via the perineal urethral route. This type of infection, which is known as community-acquired urinary tract infection (CA-UTI), is generally attributed to women. This infection may be host-specific, due to the existence of receptors for bacterial adhesins, or mediated by potent virulence factors that are
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