Virulence Factors of E-coli Isolates from Urogenital Tract Infections in Women: A Cross- Sectional Study from Hilla City, Iraq
Abstract
Background: Urogenital tract infections (UTIs) represent a significant public health concern, particularly among women. Escherichia coli remains the predominant uropathogen, with various virulence factors contributing to pathogenesis and treatment complications.
Objective: To investigate the prevalence and characteristics of virulence factors among E. coli isolates from women with urogenital tract infections in Hilla City, Iraq.
Methods: A cross-sectional study was conducted on 100 women presenting with UTI symptoms at hospitals and private clinics in Hilla City between January and August 2025. Bacterial isolates were identified using standard microbiological techniques. E. coli isolates (n=60) were analyzed for biofilm formation, capsule production, and serum resistance using standardized laboratory methods.
Results: Of 100 positive cultures, E. coli was the most prevalent pathogen (60%), followed by Klebsiella spp. (20%), Staphylococcus spp. (10%), Proteus spp. (5%), Pseudomonas spp. (2%), and other organisms (3%). Among 60. E. coli isolates, biofilm formation was observed in 90% of strains: moderate (50%), weak (25%), and strong (15%). All isolates (100%) demonstrated capsule production. Serum resistance was present in 92% of isolates: moderate (42%), strong (33%), and weak (25%). Strong positive correlation was found between biofilm formation strength and optical density readings (r=0.853, p<0.001).
Conclusions: The high prevalence of virulence factors among E. coli isolates in Hilla City indicates significant pathogenic potential. These findings highlight the urgent need for enhanced surveillance, antimicrobial stewardship, and targeted therapeutic approaches to improve UTI management.
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References
Alhomoud, F., Aljamea, Z., Almahasnah, R., Alkhalifah, K., Basalelah, L., & Alhomoud, F. K. (2017). Self-medication and self-prescription with antibiotics in the Middle East—do they really happen? A systematic review of the prevalence, possible reasons, and outcomes. International journal of infectious diseases, 57, 3-12.
Al-Tawfiq, J. A., Laxminarayan, R., & Mendelson, M. (2017). How should we respond to the emergence of plasmid-mediated colistin resistance in humans and animals?. International Journal of Infectious Diseases, 54, 77-84.
Anker, S. D., Butler, J., Filippatos, G., Ferreira, J. P., Bocchi, E., Böhm, M., ... & Packer, M. (2021). Empagliflozin in heart failure with a preserved ejection fraction. New England Journal of Medicine, 385(16), 1451-1461.
Cabrera, A., Mason, E., Mullins, L. P., & Sadarangani, M. (2025). Antimicrobial resistance and vaccines in Enterobacteriaceae including extraintestinal pathogenic Escherichia coli and Klebsiella pneumoniae. npj Antimicrobials and Resistance, 3(1), 1-14.
Cao, Z., & Liu, J. (2024). Coated bacteria: Advanced living materials for microbial therapy. Accounts of Materials Research, 5(7), 872-883.
Carruthers, V. B. (2024). Apicomplexan pore-forming toxins. Annual Review of Microbiology, 78.
Elyounsi, N., Alazabi, F., Al-Haddad, S., AL-ahmar, O., & Abolqasim, A. (2025). Urinary Tract Infections in Elderly Patients in Tripoli, Libya: A Study on Bacterial Isolation and Antimicrobial Susceptibility. Khalij-Libya Journal of Dental and Medical Research, 141-148.
Flores-Mireles, A., Hreha, T. N., & Hunstad, D. A. (2019). Pathophysiology, treatment, and prevention of catheter-associated urinary tract infection. Topics in spinal cord injury rehabilitation, 25(3), 228-240.
Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., ... & Goonewardene, S. S. (2018). Management Pathway for Cystitis. Basic Urological Management, 52(5), 43.
Johnson, J. R., & Russo, T. A. (2018). Acute pyelonephritis in adults. New England Journal of Medicine, 378(1), 48-59.
Ko, Y. H., Choi, J. Y., & Song, P. H. (2019). Host-pathogen interactions in urinary tract infections. Urogenital Tract Infection, 14(3), 71-79.
Kwok, M., McGeorge, S., Mayer‐Coverdale, J., Graves, B., Paterson, D. L., Harris, P. N., ... & Roberts, M. J. (2022). Guideline of guidelines: management of recurrent urinary tract infections in women. BJU international, 130, 11-22.
Mahmoud, Y. A. G., El-Naggar, M. E., Abdel-Megeed, A., & El-Newehy, M. (2021). Recent advancements in microbial polysaccharides: Synthesis and applications. Polymers, 13(23), 4136.
Manobala, T. (2025). Peptide-based strategies for overcoming biofilm-associated infections: a comprehensive review. Critical Reviews in Microbiology, 51(4), 563-580.
Salinas Jr, J. H., Gordesli-Duatepe, F. P., Diaz-Sanchez, A., & Abu-Lail, N. I. (2025). Phenotypic Characterization of pilA, pilB, and pilD Mutants of Acinetobacter baumannii 5075: Impacts on Growth, Biofilm Formation, and Tazobactam Response. Antibiotics, 14(8), 816.
Sande, C., & Whitfield, C. (2021). Capsules and extracellular polysaccharides in Escherichia coli and Salmonella. EcoSal Plus, 9(2), eESP-0033.
Singh, A., Amod, A., Pandey, P., Bose, P., Pingali, M. S., Shivalkar, S., ... & Samanta, S. K. (2022). Bacterial biofilm infections, their resistance to antibiotics therapy and current treatment strategies. Biomedical Materials, 17(2), 022003.
Viksne, R., Racenis, K., Broks, R., Balode, A. O., Kise, L., & Kroica, J. (2023). In vitro assessment of biofilm production, antibacterial resistance of staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp. obtained from tonsillar crypts of healthy adults. Microorganisms, 11(2), 258.
Zheng, T., & Zhang, C. (2024). Engineering strategies and challenges of endolysin as an antibacterial agent against Gram‐negative bacteria. Microbial biotechnology, 17(4), e14465.
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