Work

Phenotypic and genotypic characterization of antimicrobial-resistant uropathogens in community settings of India: A multicentric cross-sectional study

Year: 2026

Type: article

Abstract: • Prevalence of CA-UTI was found higher in elderly men than in reproductive-age women • ST131 of E.coli and ST15/16/231 of K.pneumoniae showed higher ESBL-positivity • Higher susceptibility only to fosfomycin and nitrofurantoin, is matter of concern • Carbapenem resistance same as Asian countries, but higher than in Western countries • bla NDM-5 gene was the commonest in both the E. coli and K. pneumoniae isolates This study determines the prevalence and genomic characterisation of uropathogens causing community-acquired urinary tract infections (CA-UTIs). This is a first multi-centric cross-sectional community study conducted across different regions of India, in patients aged >1.5 years suspected with UTI. Uropathogens causing significant bacteriuria were identified, and susceptibility testing was performed. Whole-genome sequencing (WGS) was done to characterise antimicrobial resistance (AMR) genes, virulence genes, and sequence types (ST). The effect of age and gender on significant bacteriuria was assessed by Multivariable random-effects logistic regression. Significant bacteriuria was seen in 11.8% (711/6,009) of the specimens out of which, 63% (448/711) were Escherichia coli ; and 15.7% (112/711) were Klebsiella pneumoniae . The prevalence of extended-spectrum-beta-lactamase (ESBL) positive, multidrug-resistant (MDR) and carpabenem resistant E. coli was 39.2% (44/112), 64.5% (289/488) and 9.82% (44/448); among K. pneumoniae isolates, similar resistance was seen in 56.2% (63/112), 65.4% (293/448), and 9.82% (11/112), respectively. Genomic analysis showed high-risk clones of E. coli (ST131, ST1193) and K. pneumoniae (ST15, ST16, and ST231) carrying multiple plasmids with bla CTX-M-15 , bla OXA-232 , bla NDM-5 , and bla NDM-7 genes. This study revealed a wider presence of drug resistant high-risk clones of uropathogens in community-settings of India. A multifaceted approach through routine AMR surveillance, judicious choice of empiric antibiotics in a community-setting, is deemed necessary. WGS analysis of ESBL-producing E. coli isolates revealed a predominance of ST131 lineage (25%), while ST1193 strains carried IncFIA and ColKP3 plasmids associated with bla CTX-M-15 and bla TEM-1B . ST231 K. pneumoniae isolates harboured bla OXA-32 gene along with ColKP3 plasmid.

Source: Journal of Global Antimicrobial Resistance

DOI: 10.1016/j.jgar.2026.02.003