الفهرس 
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Abstract
UTI is one of the most common types of infection in human with an established 34% of adults aged 20 or older reported as having had at least one occurrence of UTI or cystitis. Specifically, over 50% of women and over 13% of men will have a UTI at least in their lifetime. This results in repeated doctor’s visits and a cost of several billions every year. E. coli is the most common organism causing both community as well as hospital acquired UTI.
The aim of this study was to detect the association of some virulence factors of UPEC strains and pap adhesion encoding operon gene which is responsible for adhesion of E.coli to the uroepithelium as cell surface hydrophobicity, haemolysin production, serum resistance, gelatinase production and extended spectrum β lactamase production.
This work was carried out in Microbiology and Immunology Department, Benha Faculty of Medicine during the period between January 2014 and March 2015 on eighty patients attending to the Outpatient Clinic of Urology Department of Benha University Hospital suffering from UTI. Clean catch mid stream urine samples were collected from those patients in sterile screw capped containers. The patients were
27 males and 53 females and their age ranged between 15 to 60 years old. Twenty stool samples were collected from healthy individuals matched for age and sex with the patient group (control group). Written consent was taken from each patient.
Twenty patients were suffering from UTI for the first time and 60 patients were suffering from a recurrent attack.
Each collected urine samples was divided into 2 halves:
• The first half of urine sample was used to perform viable count without centrifugation; 73 urine samples gave bacterial count
≥105 CFU/ml (significant bacteriuria).
• The 2nd half of urine sample was centrifuged and the deposit was used for isolation and identification of E.coli and other isolated bacteria.
They were centrifuged and the sediments were cultured on MacConkey agar plates and incubated for 24h at 37°C. Stool samples were cultured directly on MacConkey agar plates and incubated for 24h at 37°C.
Lactose fermenting colonies were identified as E.Coli by Gram- stained films and biochemical reaction.
Antimicrobial susceptibility testing was performed for six different therapeutically relevant antibiotics to uropathogenic and commensal E.coli isolates.
The isolated UPEC and commensal E.coli strains were tested for presence of some virulence factors like cell surface hydrophobicity, haemolysin production, serum resistance, gelatinase production and ESβL production.
The isolated UPEC and commensal E.coli strains that were resistant or intermediate sensitive to Cefotaxime (30µg) and ceftazidime (30µg) were subjected to test of ESβL production by using cefotaxime
/clavulanic acid 30 ⁄10 µg and Cefotaxime/clavulanic acid 30 ⁄10 µg discs.
The isolated UPEC and commensal E.coli strains were subjected to PCR for detection of pap gene responsible for pili formation.
The result of the study showed the following:
•Out of 80 cultured urine samples 73 (91.25%) strains were isolated: 50
E.coli (62.5%), 11 Enterococci (13.8%), 4 Klebsiella aerogenes (5.0%),
3 Pseudomonas aeruginosa (3.7%), 3 proteus mirabilis (3.7%) and 2
Citrobacter (2.5%) while 7 urine samples show no growth.
• Antibiotic sensitivity pattern of isolated UPEC showed that out of 50 isolated uropathogenic strains: 33(66%) strains show resistance to ampicillin (10µg). 45 (90%) strains show sensitivity to amikacin (30µg). For ciprofloxacin (5µg): 34(68%) strains show sensitivity. 40 (80%) strains show sensitivity to gentamycin(10µg). For cefotaxime (30µg): 17(34%) strains, and 24 (48%) strains show resistance, and sensitivity respectively. For ceftazidime(30µg): 42(84%) strains show resistance.
• Antibiotic sensitivity pattern of the isolated commensal E.coli strains showed that out of 20 isolated commensal E.coli strains: 12(60%) strains show resistance to ampicillin(10µg). 17(85%) strains show sensitivity to amikacin (30µg). For ciprofloxacin (5µg): 18 (90%) strains show sensitivity. Twenty (100%) strains show sensitivity to gentamycin (10µg). For cefotaxime (30µg):12(60%) strains show sensitivity. For ceftazidime(30µg): 16(80%) strains show resistance.
• 26/50 (52%) of isolated UPEC strains and 8/20 (40%) of isolated commensal E.coli strains were ESBL producers.
• The results of virulence factors of UPEC showed that 46 % were hydrophobic, 24% were haemolysin producers, 62% were serum resistant and only 2% liquefied gelatin and 52% were ESBL producers.
• The results of virulence factors of commensal E.coli showed that 45 % were hydrophobic, 15% were haemolysin producers, 55% were serum resistant, 40% were ESBL producers and no strains (0%) can liquefy gelatin.
• The result of pap gene detection showed that: 72% of isolated UPEC strains harboring pap gene while 60 % of isolated commensal E.coli strains harboring pap gene.
So, as regard the association of virulence factors of UPEC and pap gene it can be concluded that there is insignificant statistical value for the association of each of cell surface hydrophobicity, serum resistant and ESPL production with pap gene while there is highly significant statistical value for the association of haemolysin and gelatinase production with pap gene in the isolated UPEC.
Also there is insignificant statistical value for the association of each of cell surface hydrophobicity and serum resistant with pap gene while there is highly significant statistical value for the association of haemolysin, gelatinase production and ESPL production with pap gene in the isolated commensal E.coli strains.
• Comparison between pap gene in uropathogenic and commensal E.coli strains revealed that there was insignificant statistical value between presence of pap gene in uropathogenic and commensal E.coli strains.