Comparative Study of the Genomic Characteristics of Uropathogenic Escherichia Coli According to the Severity of Community-Acquired Urinary Tract Infections in Guadeloupe (COLIGENURI)

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, with nearly 150 million cases each year. They affect individuals across all age groups and represent a substantial burden in terms of public health and economic costs. While most cases begin as mild cystitis, UTIs can progress to severe forms such as pyelonephritis or bacteremia, particularly in the presence of predisposing factors such as urinary stasis, catheterization, or biofilm formation.

The predominant etiological agent is Escherichia coli, especially its uropathogenic strains (UPEC). These strains differ from commensal intestinal E. coli by their extensive arsenal of virulence factors enabling colonization and persistence within the urinary tract. A central mechanism is adhesion to urothelial cells, mediated notably by P fimbriae and PapG adhesin variants, whose distribution is associated with tissue tropism (papGII in pyelonephritis, papGIII in cystitis). UPEC also evade host immunity through the formation of intracellular bacterial communities and the production of 180 toxins such as hemolysin HlyA and cytotoxic necrotizing factor 1 (CNF1), which promote invasion and bacterial dissemination.

A major concern is the emergence of highly virulent and resistant clones. The Sequence Type (ST) 131 lineage exemplifies this convergence, combining virulence factors, biofilm formation, and multidrug resistance, notably through the production of CTX-M-type extended-spectrum beta-lactamases carried on plasmids with high dissemination potential. These characteristics make ST131 a key driver of complicated UTIs and therapeutic failures, posing a critical global public health challenge.

In the French Caribbean, and particularly in Guadeloupe, data linking the genomic profiles of UPEC strains to the clinical severity of infections remain scarce. Identifying genomic signatures predictive of disease severity would enable better patient stratification at the time of diagnosis and facilitate early adaptation of management strategies (targeted antibiotic therapy, hospitalization, or closer monitoring). With the development of high-throughput sequencing, bioinformatics, and artificial intelligence tools, personalized, preventive, and more efficient medicine is becoming increasingly achievable. Furthermore, recent studies have revealed that certain environmental strains share important genetic similarities with human pathogenic clones, suggesting possible inter-reservoir circulation. These findings underscore the importance of an integrated One Health approach, as promoted by the World Health Organization (WHO), which emphasizes the interconnectedness of human, animal, and environmental health. In an insular territory such as Guadeloupe, characterized by high population density, strong anthropogenic pressures, and fragile ecosystems, this approach is particularly relevant to understanding local transmission dynamics and anticipating the emergence of multidrug-resistant and/or highly virulent strains.