# Third-Generation Cephalosporin-Resistant Uropathogenic Escherichia coli From Community- and Hospital-Acquired Infections Show High Level of Antibiotic Resistance and Specific Virulence Traits

## TL;DR

This study compares antibiotic resistance and virulence traits of third-generation cephalosporin-resistant E. coli from hospital and community infections in Algeria.

## Contribution

It reveals that community-acquired strains are more virulent, while hospital strains show higher resistance levels and similar resistance profiles.

## Key findings

- All 3GC-resistant E. coli isolates were multidrug-resistant with no significant difference in resistance profiles between hospital and community isolates.
- Community isolates showed higher motility, biofilm production, and belonged to more virulent Phylogroup B2 compared to hospital isolates.
- Hospital isolates predominantly belonged to Phylogroup A and exhibited less virulence despite higher resistance levels.

## Abstract

Escherichia coli is a leading cause of both community-acquired and nosocomial infections. In particular, E. coli is responsible for 90% of all uncomplicated urinary tract infections (UTIs) and 65% of complicated UTIs. Among complicated UTIs, those caused by third-generation cephalosporin (3GC)–resistant E. coli strains, expressing extended-spectrum beta-lactamases (ESBLs), are on the rise. These strains show often a multidrug-resistant (MDR) phenotype, limiting the therapeutic options and the increasing incidence of MDR E. coli in Algeria is concerning. This study aims to compare the antibiotic resistance rates and profiles as well as the virulence traits between 3CG-resistant E. coli isolates, collected from Algerian inpatients (IPs) and outpatients (OPs). Our analyses include phenotypic and genotypic resistance factor detection, strains classification by genotyping and phylogrouping, as well as genotypic and phenotypic virulence factor evaluation. Among 42 E. coli isolates, 76.20% caused UTIs. ESBL producers (n = 35) carried all the blaCTX−M, while blaTEM was found in 69.04% of isolates. All isolates were MDR, and no significant differences in type and rate of antibiotic resistance were observed between IP- and OP-isolates. OP-isolates demonstrated greater virulence, exhibiting higher motility and biofilm production, compared to IP-isolates. Moreover, pathogenic Phylogroup B2 was prevalent among OP-isolates, while IP-isolates belonged predominantly to Phylogroup A. Our data suggest a uniform spreading of antibiotic-resistant genes within hospitals and communities. However, hospital environment selects for less virulent strains with increasing level of resistance; differently, communities host more virulent strains. This study highlights the urgent need to implement the surveillance of 3CG-resistant E. coli and to adopt the One Health approach to monitor the antimicrobial resistance (AMR) in the country.