Abstract
Simple Summary To date, despite the efforts made to monitor the wide spread of resistant pathogens, especially multidrug-resistant (MDR) diarrheagenic E. coli, there are limitations in the correlation analysis for these pathogens worldwide. Therefore, it seems important and so timely to assess the E. coli pathotypes and their correlations with hosts, antimicrobial resistance, virulence gene profiles, and serotypes. Our promising results gave a clear indication for the epidemic situation of diarrheagenic E. coli (DEC) in Egypt and suggested that restricted recommendations and a search for novel alternative therapies are urgently needed due to the wide spread of MDR and multi-virulent E. coli strains in addition to their heterogeneous nature. This study can be implemented in the infection control guidance with enhanced protocols to hinder the spread of MDR E. coli pathotypes in Egyptian hospitals. The treatment failure recorded among patients and animals infected with diarrheagenic Escherichia coli (DEC) was increased due to the presence of specific virulence markers among these strains. These markers were used to classify DEC into several pathotypes. We analyzed the correlations between DEC pathotypes and antimicrobial resistances, the existence of virulence genes, serotypes, and hosts. The ETEC pathotype was detected with a high prevalence rate (25%). Moreover, the ETEC and EPEC pathotypes were highly associated with human infections in contrast to the EIEC and EAEC phenotypes, which were commonly recognized among animal isolates. Interestingly, the antimicrobial resistance was affected by E. coli pathotypes. With the exception of EIEC and STEC, imipenem represented the most effective antibiotic against the other pathotypes. There were fixed correlations between the DEC pathotypes and the presence of virulence markers and hosts; meanwhile, their correlation with serotypes was variable. Additionally, the vast majority of our isolates were highly diverse, based on both phenotypic and ERIC molecular typing techniques. Our promising results gave a clear indication for the heterogeneity and weak clonality of DEC pathotypes in Egypt, which can be utilized in the evaluation of the current therapeutic protocols and infection control guidelines.