{
    "abstract": "Escherichia coli (E. coli) is a multidrug resistant opportunistic pathogen that can cause secondary bacterial infections in patients with COVID-19. This study aimed to determine the antimicrobial resistance profile of E. coli as a secondary bacterial infection in patients with COVID-19 and to assess the prevalence and characterization of genes related to efflux pumps and porin.\nA total of 50 nonduplicate E. coli isolates were collected as secondary bacterial infections in COVID-19 patients. The isolates were cultured from sputum samples. Confirmation and antibiotic susceptibility testing were conducted by Vitek 2. PCR was used to assess the prevalence of the efflux pump and porin-related genes in the isolates. The phenotypic and genotypic evolution of antibiotic resistance genes related to the efflux pump was evaluated.\nThe E. coli isolates demonstrated high resistance to ampicillin (100%), cefixime (62%), cefepime (62%), amoxicillin-clavulanic acid (60%), cefuroxime (60%), and ceftriaxone (58%). The susceptibility of E. coli to ertapenem was greatest (92%), followed by imipenem (88%), meropenem (86%), tigecycline (80%), and levofloxacin (76%). Regarding efflux pump gene combinations, there was a significant association between the acrA gene and increased resistance to levofloxacin, between the acrB gene and decreased resistance to meropenem and increased resistance to levofloxacin, and between the ompF and ompC genes and increased resistance to gentamicin.\nThe antibiotics ertapenem, imipenem, meropenem, tigecycline, and levofloxacin were effective against E. coli in patients with COVID-19. Genes encoding efflux pumps and porins, such as acrA, acrB, and outer membrane porins, were highly distributed among all the isolates. Efflux pump inhibitors could be alternative antibiotics for restoring tetracycline activity in E. coli isolates.",
    "authors": [
        {
            "affiliation": "Department of Clinical Analysis, College of Pharmacy, Hawler Medical University, Erbil, Kurdistan Region, Iraq.\nDepartment of Medical Analysis, Faculty of Applied Science, Tishk International University, Erbil, Iraq.",
            "firstname": "Aryan R",
            "initials": "AR",
            "lastname": "Ganjo"
        },
        {
            "affiliation": "Department of Medical Analysis, Faculty of Applied Science, Tishk International University, Erbil, Iraq. salah.balaky@hmu.edu.krd.\nDepartment of Medical Microbiology, College of Health Sciences, Hawler Medical University, Erbil, Kurdistan Region, Iraq. salah.balaky@hmu.edu.krd.",
            "firstname": "Salah Tofik Jalal",
            "initials": "STJ",
            "lastname": "Balaky"
        },
        {
            "affiliation": "Department of Medical Microbiology, College of Health Sciences, Hawler Medical University, Erbil, Kurdistan Region, Iraq.\nDepartment of Medical Laboratory Technique, College of Medical Technology, AL-Kitab University, Kirkuk, Iraq.",
            "firstname": "Ahang Hasan",
            "initials": "AH",
            "lastname": "Mawlood"
        },
        {
            "affiliation": "Par Hospital, Erbil, Kurdistan Region, Iraq.",
            "firstname": "Sakar B",
            "initials": "SB",
            "lastname": "Smail"
        },
        {
            "affiliation": "College of Health Sciences, Catholic University in Erbil, Erbil, Kurdistan Region, Iraq.\nDepartment of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.",
            "firstname": "Nazar P",
            "initials": "NP",
            "lastname": "Shabila"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2024. The Author(s).",
    "doi": "10.1186/s12866-024-03283-8\n10.1093/cid/ciac401\n10.3389/fpubh.2020.00383\n10.3390/antibiotics12020409\n10.1097/HC9.0000000000000038\n10.1186/s13613-023-01146-5\n10.1186/s12879-022-07192-x\n10.1097/MCC.0000000000000860\n10.1016/j.cmi.2021.05.040\n10.3390/antibiotics12010155\n10.3390/pathogens12010038\n10.1093/jac/dkv109\n10.3390/jox11040013\n10.3390/ijms24021515\n10.3389/fmicb.2018.02990\n10.1038/nmicrobiol.2017.1\n10.1186/s42522-021-00035-w\n10.1186/s12866-019-1589-1\n10.1021/acsinfecdis.6b00167\n10.1038/ncomms10731\n10.1016/j.bcp.2016.10.005\n10.1016/j.genrep.2020.100666\n10.3390/microorganisms11071690\n10.1007/s10096-020-04142-w\n10.1371/journal.pone.0279713\n10.1371/journal.pone.0266787\n10.1038/s41598-022-19289-z\n10.1016/j.bioorg.2017.08.004\n10.1590/s1678-9946202062088\n10.1177/1178636119889629\n10.1186/s13104-019-4177-4\n10.1021/acs.est.6b03132\n10.1007/s00134-020-05991-x\n10.1016/j.cmi.2020.06.025\n10.1007/s00134-020-06323-9\n10.5005/jp-journals-10071-23781\n10.1007/s00253-021-11740-x\n10.5958/0974-4517.2022.00052.0\n10.1128/AEM.02792-18\n10.1093/jac/dkp027\n10.1016/j.ijantimicag.2017.03.005\n10.1016/j.ejphar.2021.174151\n10.3389/fmicb.2017.00228\n10.1126/science.aav6390\n10.3390/antibiotics11040520\n10.1016/j.genrep.2020.100873\n10.3390/antibiotics12060965\n10.1128/AAC.45.4.1126-1136.2001\n10.3389/fmicb.2019.00953\n10.1016/j.sjbs.2022.02.036",
    "journal": "BMC microbiology",
    "keywords": [
        "Escherichia coli",
        "Antibiotic resistance",
        "CCCP",
        "COVID-19",
        "Efflux pumps"
    ],
    "methods": null,
    "publication_date": "2024-04-11",
    "pubmed_id": "38600509\n35749696\n32850602\n36830319\n36669500\n37322293\n35236299\n34321415\n34481722\n36671356\n36678386\n25953808\n34940513\n36675027\n30619113\n28224989\n33829140\n31488061\n27768847\n26867482\n27765485\n37512863\n33389263\n36662716\n35536848\n36050365\n34550809\n28841421\n33206862\n31839709\n30871640\n27997135\n31871232\n32125452\n32603803\n33388794\n34045801\n35050388\n33868645\n35378893\n30578262\n19240073\n28533185\n33964293\n28261184\n31123134\n35453271\n37370284\n11257026\n31114568\n35844436\n26862399\n37556067",
    "results": "The E. coli isolates demonstrated high resistance to ampicillin (100%), cefixime (62%), cefepime (62%), amoxicillin-clavulanic acid (60%), cefuroxime (60%), and ceftriaxone (58%). The susceptibility of E. coli to ertapenem was greatest (92%), followed by imipenem (88%), meropenem (86%), tigecycline (80%), and levofloxacin (76%). Regarding efflux pump gene combinations, there was a significant association between the acrA gene and increased resistance to levofloxacin, between the acrB gene and decreased resistance to meropenem and increased resistance to levofloxacin, and between the ompF and ompC genes and increased resistance to gentamicin.",
    "title": "Characterization of genes related to the efflux pump and porin in multidrug-resistant Escherichia coli strains isolated from patients with COVID-19 after secondary infection.",
    "xml": "<Element 'PubmedArticle' at 0x78850368c270>"
}