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This dissertation, Epidemiology and Virulence Characteristics of Multidrug-resistant Escherichia Coli From Women With Acute Uncomplicated Cystitis by 葉景新, King-sun, Yip, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Abstract of thesis entitled Epidemiology and virulence characteristics of multidrug-resistant Escherichia coli from women with acute uncomplicated cystitis submitted by Yip King Sun for the degree of Master of Philosophy at the University of Hong Kong in August 2007 Background: The emergence of antibiotic-resistant, uropathogenic Escherichia coli is an important public health issue. It is not clear if antibiotic-resistant strains are as virulent as their susceptible counterparts. Objectives: This prospective study investigated the epidemiology and virulence characteristics of antibiotic-resistant E. coli causing uncomplicated cystitis in outpatient females. Methods: Urine cultures were obtained from adult women presenting to participating outpatient clinics with uncomplicated cystitis. Patient demographics were obtained by a standard questionnaire. Multidrug-resistant (MDR) E. coli isolates were analyzed for virulence profiles, phylogenetic groups, clonality and compared to control strains fully susceptible to antibiotics. Results: Among 430 UTI cases recruited from private doctors and GOPCs, 275 E. coli strains were isolated with a positive rate of 64%. The 72 (33.3%) isolates of E. coli and 10 (28%) of other Enterobacteriaceae were found to exhibit multidrug resistance. Twenty-four (33.3%) and 1 (8.3%) of the MDR E. coli and other Enterobacteriaceae were also co-resistant to ampicillin, ciprofloxacin, and trimethoprim-sulfamethoxazole, which were the antimicrobial agents commonly prescribed for UTI treatments. Previous antibiotic treatment within the past six weeks before diagnosis was associated with the emergence of ciprofloxacin, trimethoprim-sulfamethoxazole and multidrug resistance. Phylogenetic group B2 predominated in both the MDR and pansusceptible isolates. Distinct differences of extended VF profiles between MDR and pansusceptible E. coli isolates were found. Out of the 29 VF genes studied, siderophore and miscellaneous VF genes were shown to be positively associated with MDR isolates. These included iutA, cvaC and traT genes. In the conjugation, only the traT gene was able to be co-transferred by conjugation to ESBL producers. Conclusion: An association was found between previous antimicrobial agent exposures and the emergence of MDR E. coli. Distinct extended VF profiles among MDR and pansusceptible E. coli underlined the presence of an external source of E. coli that represented different lineages to the host E. coli. (Word count = 305) DOI: 10.5353/th_b3955744 Subjects: Escherichia coli infectionsCystitisDrug resistance in microorganismsWomen - Diseases

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