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<p>Polymicrobial urinary tract infections (UTIs) involving the concurrent presence of <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> in a single urine specimen represent a clinically under-recognised entity associated with elevated multidrug resistance (MDR) rates and complicated therapeutic outcomes. Automated cassette-based platforms capable of resolving dual-species infections within a single analytical run have not been specifically evaluated for this diagnostic application. To determine the prevalence of <i>E. coli</i>–<i>K. pneumoniae</i> coinfections among UTI patients in Baghdad, Iraq, and to characterise the distribution and phenotypic associations of the resistance gene <i>acrD</i>, the virulence gene <i>galU</i>, and the quorum-sensing regulator <i>qseC</i> in confirmed coinfection isolates, using the Render MA120 automated system as the primary diagnostic platform. Two hundred midstream urine samples were collected from patients with suspected UTIs in Baghdad hospitals. Species identification and antimicrobial susceptibility testing (AST) were performed simultaneously on the Render MA120 cassette-based system (CLSI 2022). Confirmed dual-species isolates were subjected to PCR-based detection of <i>qseC</i>, <i>galU</i>, and <i>acrD</i>. Statistical analyses used SPSS version 26 (<i>p</i> ≤ 0.05). Dual-species coinfection was confirmed in 9 of 200 specimens (4.5%), with 66.7% of coinfected isolates classified as MDR. <i>K. pneumoniae</i> showed significantly higher resistance than <i>E. coli</i> for ampicillin/sulbactam (<i>p</i> = 0.045), cefepime (<i>p</i> = 0.022), and aztreonam (<i>p</i> = 0.048). The <i>acrD</i> gene was detected in 92.8% of isolates, <i>galU</i> in 71.4%, and <i>qseC</i> in 35.7% (overall <i>p</i> = 0.003). Preliminary gene–phenotype associations were observed for all three determinants (<i>p</i> = 0.042), though these require validation in larger cohorts. To our knowledge, this study represents one of the first applications of the Render MA120 system to <i>E. coli</i>–<i>K. pneumoniae</i> dual-species UTI detection, and provides preliminary data on the co-occurrence of <i>qseC</i>, <i>galU</i>, and <i>acrD</i> in this polymicrobial context. All findings are hypothesis-generating and require replication in larger multicentre studies.</p>

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First report of render MA120-assisted identification of dual-species urinary tract coinfection by Escherichia coli and Klebsiella pneumoniae: molecular characterization of qseC, galU, and acrD resistance and virulence determinants

  • 期刊论文

  • 发表日期：

    2026年6月17日

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  • Rand Hatam Kalo,
  • Marwa Hameed Alkhafaji

摘要

Polymicrobial urinary tract infections (UTIs) involving the concurrent presence of Escherichia coli and Klebsiella pneumoniae in a single urine specimen represent a clinically under-recognised entity associated with elevated multidrug resistance (MDR) rates and complicated therapeutic outcomes. Automated cassette-based platforms capable of resolving dual-species infections within a single analytical run have not been specifically evaluated for this diagnostic application. To determine the prevalence of E. coli–K. pneumoniae coinfections among UTI patients in Baghdad, Iraq, and to characterise the distribution and phenotypic associations of the resistance gene acrD, the virulence gene galU, and the quorum-sensing regulator qseC in confirmed coinfection isolates, using the Render MA120 automated system as the primary diagnostic platform. Two hundred midstream urine samples were collected from patients with suspected UTIs in Baghdad hospitals. Species identification and antimicrobial susceptibility testing (AST) were performed simultaneously on the Render MA120 cassette-based system (CLSI 2022). Confirmed dual-species isolates were subjected to PCR-based detection of qseC, galU, and acrD. Statistical analyses used SPSS version 26 (p ≤ 0.05). Dual-species coinfection was confirmed in 9 of 200 specimens (4.5%), with 66.7% of coinfected isolates classified as MDR. K. pneumoniae showed significantly higher resistance than E. coli for ampicillin/sulbactam (p = 0.045), cefepime (p = 0.022), and aztreonam (p = 0.048). The acrD gene was detected in 92.8% of isolates, galU in 71.4%, and qseC in 35.7% (overall p = 0.003). Preliminary gene–phenotype associations were observed for all three determinants (p = 0.042), though these require validation in larger cohorts. To our knowledge, this study represents one of the first applications of the Render MA120 system to E. coli–K. pneumoniae dual-species UTI detection, and provides preliminary data on the co-occurrence of qseC, galU, and acrD in this polymicrobial context. All findings are hypothesis-generating and require replication in larger multicentre studies.