الفهرس 
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Abstract
The cause of the global rise of ESBL-producing Gram-negative bacteria is a big concern, and demands intensified surveillance. ESBL genes were discovered in E. coli isolates both from humans and from environmental waters, suggesting frequent and continuous intercompartment transmission between humans and the aquatic environment. Public health efforts should focus on the correct use of antibiotics to limit their dissemination and further investigation of molecular epidemiology of ESBLs in various clinical and environmental samples would be promising to get a good database for ESBL- producing E. coli in Egypt. This multi-centre study is one of the first studies to provide comprehensive molecular and epidemiological insights regarding the antimicrobial susceptibility patterns, the prevalence of phylotypes among UTI patients, healthy humans, water wastewater and cattle feces isolates, the characterization of integrons and integron associated gene cassettes among UPEC isolates from CA-UTIs in Upper Egypt.
The main findings of this study include the following: (i) the high prevalence of MDR phenotypes among all the collected samples; (ii) the prevalence of a relatively narrow range of phylotypes among our isolates, with the predominance of the B2 group strains; (iii) the carriage of Class 1 integrons containing antimicrobial resistance genes among the UTI isolates, with the possibility that these mobile elements could be transmitted to different pathogens; and (iv) the detection of three gene cassette arrangements among our integron positive isolates, containing different alleles of aadA (three alleles) and dfrA (two alleles) genes, which encode streptomycin / spectinomycin and trimethoprim resistance, respectively, as well as an open reading frame (ORF) of unknown function.
Our findings report that WWTPs release large amounts of ESBLEC into the Egyptian environment. In addition, our study observed that blaCTX-M was the most abundant ESBL-associated gene among environmental E. coli and also in UTI isolates. Our results indicate that UPEC strains in the wastewater and Nile River belong to phylogroup B2, which is the predominant phylogroup in UTIs. Moreover, UPEC strains are also a vehicle for transmission of AMR genes especially the epidemiological blaCTX-M. It was detected that AMRs are spreading from environment to animals and humans; so AMR screening via multiple approaches may assist in the prevention of drug-resistant E. coli spread from waters to animals and humans.