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<article xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" article-type="research-article" xml:lang="en">
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">OJVR</journal-id>
<journal-title-group>
<journal-title>ONDERSTEPOORT Journal of Veterinary Research</journal-title>
</journal-title-group>
<issn pub-type="ppub">0030-2465</issn>
<issn pub-type="epub">2219-0635</issn>
<publisher>
<publisher-name>AOSIS</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">OJVR-85-1621</article-id>
<article-id pub-id-type="doi">10.4102/ojvr.v85i1.1621</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Original Research</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Molecular analysis of Shiga toxin-producing <italic>Escherichia coli</italic> O157:H7 and non-O157 strains isolated from calves</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5578-5541</contrib-id>
<name>
<surname>Kohansal</surname>
<given-names>Maryam</given-names>
</name>
<xref ref-type="aff" rid="AF0001">1</xref>
<xref ref-type="aff" rid="AF0002">2</xref>
</contrib>
<contrib contrib-type="author">
<contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-6423-4680</contrib-id>
<name>
<surname>Ghanbari Asad</surname>
<given-names>Ali</given-names>
</name>
<xref ref-type="aff" rid="AF0001">1</xref>
</contrib>
<aff id="AF0001"><label>1</label>Department of Medical Biotechnology, Fasa University of Medical Science, Iran</aff>
<aff id="AF0002"><label>2</label>Department of Biology, Payame Noor University (PNU), Iran</aff>
</contrib-group>
<author-notes>
<corresp id="cor1"><bold>Corresponding author:</bold> Maryam Kohansal, <email xlink:href="k_kohansal@yahoo.com">k_kohansal@yahoo.com</email></corresp>
</author-notes>
<pub-date pub-type="epub"><day>17</day><month>10</month><year>2018</year></pub-date>
<pub-date pub-type="collection"><year>2018</year></pub-date>
<volume>85</volume>
<issue>1</issue>
<elocation-id>1621</elocation-id>
<history>
<date date-type="received"><day>27</day><month>02</month><year>2018</year></date>
<date date-type="accepted"><day>15</day><month>08</month><year>2018</year></date>
</history>
<permissions>
<copyright-statement>&#x00A9; 2018. The Authors</copyright-statement>
<copyright-year>2018</copyright-year>
<license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/">
<license-p>Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.</license-p>
</license>
</permissions>
<abstract>
<p>Shiga toxin-producing <italic>Escherichia coli</italic> (STEC) O157 and non-O157 are food-borne pathogens and contaminants of foods of animal origin. This study was conducted to investigate the presence of virulence and integrase genes in STEC isolates from diarrhoeic calves in Fars Province, Iran. Five hundred and forty diarrheic neonatal calves were randomly selected for sampling. Rectal swabs were collected and cultured for isolation and identification of <italic>E. coli</italic> following standard methods. The isolates were analysed for the presence of class 1 integrons and bacterial virulence factors using polymerase chain reaction (PCR). Antimicrobial susceptibility testing was performed using the Kirby&#x2013;Bauer disc diffusion method. Out of 540 diarrhoeic faecal samples, 312 (57.7&#x0025;) harboured <italic>E. coli</italic> and 71 (22.7&#x0025;) of them were identified as STEC: 41(69.5&#x0025;) carried the <italic>stx2</italic> gene, 21 (35.6&#x0025;) carried the <italic>stx1</italic> gene and 3 (5&#x0025;) carried both. Twenty-six (44&#x0025;) of the isolates showed the <italic>eae</italic> gene. Among the STEC isolates examined for susceptibility to eight antimicrobial agents, erythromycin and penicillin (96.8&#x0025;) resistance were most commonly observed, followed by resistances to ampicillin (71.8&#x0025;), tetracycline (62.5&#x0025;) and trimethoprim/sulfamethoxazole (39&#x0025;). Integrons were detected by PCR in 36&#x0025; of the STEC tested isolates, 57 (89&#x0025;) of which showed resistance to at least three antimicrobial agents. Our findings should raise awareness about antibiotic resistance in diarrhoeic calves in Fars Province, Iran. Class 1 integrons facilitate the emergence and dissemination of multidrug-resistance (MDR) among STEC strains recovered from food animals.</p>
</abstract>
</article-meta>
</front>
<body>
<sec id="s0001">
<title>Introduction</title>
<p>New research provides the strongest evidence that Shiga toxin-producing <italic>Escherichia coli</italic> (STEC) non-O157:H7 and in particular serogroup O157 are linked to severe gastrointestinal diseases (Dehkordi et al. <xref ref-type="bibr" rid="CIT0008">2014</xref>). The clinical manifestations of STEC infection can vary, from asymptomatic carriage to very serious illnesses such as haemolytic uremic syndrome (HUS), thrombocytopenic purpura (TTP) and haemorrhagic colitis (HC) (Thomas et al. <xref ref-type="bibr" rid="CIT0037">2012</xref>). Estimates vary, but experts suggest that gastrointestinal infections are responsible for approximately 1.5 million deaths per year, over 90&#x0025; of which are in developing countries (Montenegro et al. 2011). For instance, non-O157:H7 serogroups are found in more than 36 000 cases of infections annually and at least 73 000 are infected with O157:H7 serogroup in the United States (US) (Zhao et al. <xref ref-type="bibr" rid="CIT0045">2001</xref>).</p>
<p>Studies have revealed that O157 and non-O157 strains of cattle origin can cause the disease in humans via consumption of raw milk and undercooked meat. In fact, cattle, especially young animals, are known to be the primary reservoirs of both non-O157 and O157 STEC (Moura et al. <xref ref-type="bibr" rid="CIT0022">2012</xref>). The pathogenicity of STEC is associated with Shiga toxin (stx) encoded by Shiga toxinogenic (<italic>stx</italic>) genes 1, 2 (<italic>stx1</italic> and <italic>stx2</italic>) and an outer membrane protein which is encoded by the chromosomal <italic>eae</italic> gene (Pradel et al. <xref ref-type="bibr" rid="CIT0029">2008</xref>).</p>
<p>The problems with some new STEC strains isolated from neonatal calf diarrhoea (NCD) (Rigobelo et al. 2008), which is recognised as a disease complex characterised by acute, undifferentiated diarrhoea in newborn calves, are that antibiotic multiresistance (De Verdier et. al. <xref ref-type="bibr" rid="CIT0009">2012</xref>) and STEC strains can be transmitted to humans by contact occupational exposure and the food chain (Schroeder et al. <xref ref-type="bibr" rid="CIT0031">2002</xref>). Epidemiological observations show high levels of antimicrobial resistance in bacterial pathogens from veterinary and human medicine (Zhao et al. <xref ref-type="bibr" rid="CIT0045">2001</xref>). This has led to the discovery that these bacteria are able to acquire antibiotic resistance by resistance-conferring genes, many of which are carried on transposons, plasmids or integrons (Bakhshi, Najibi &#x0026; Sepehri-Seresht <xref ref-type="bibr" rid="CIT0002">2014</xref>). An integron is mainly composed of an integrase gene that encodes a site-specific recombinase, by which an insertion site of integron is recognised. Moreover, an integron contains a variable region which is the place for gene cassettes to be inserted (White et al. <xref ref-type="bibr" rid="CIT0044">2001</xref>). Depending on the sequence of the encoded integrases (<italic>intI</italic>) catalysing excision and integration of deoxyribonucleic acid (DNA) units, eight distinct integron classes have been identified up to now, and class 1 integrons have shown to be the major contributors to multidrug-resistant (MDR) infections in the Enterobacteriaceae family (Singh et al. <xref ref-type="bibr" rid="CIT0034">2005</xref>).</p>
<p>Many studies in various countries including Iran have shown that the distribution of integrons among enteric bacteria has increased over time (Eftekhari et al. <xref ref-type="bibr" rid="CIT0010">2013</xref>; Gonzalez et al. <xref ref-type="bibr" rid="CIT0012">1998</xref>; Hamada, Oshima &#x0026; Tsuji <xref ref-type="bibr" rid="CIT0014">2003</xref>; Martinez-Freijo et al. <xref ref-type="bibr" rid="CIT0019">1998</xref>, <xref ref-type="bibr" rid="CIT0020">1999</xref>; Najibi et al. <xref ref-type="bibr" rid="CIT0025">2012</xref>). In Iran, only a few studies have reported antimicrobial resistance properties and virulence genes in the pathogenic <italic>E. coli</italic> (Bakhshi et al. <xref ref-type="bibr" rid="CIT0002">2014</xref>; Shahrani et al. <xref ref-type="bibr" rid="CIT0033">2014</xref>). Unfortunately, there is no conclusive data on the distribution of virulence genes and the antimicrobial resistance properties of STEC strains isolated from Iran, particularly from Fars, which is one of the major agricultural and animal husbandry areas in Iran, with nearly 400 000 cattle and 8 000 000 sheep and goats (Shams et al. <xref ref-type="bibr" rid="CIT0032">2012</xref>).</p>
</sec>
<sec id="s0002">
<title>Materials and methods</title>
<sec id="s20003">
<title>Study design and study areas</title>
<sec id="s30004">
<title>Sampling and <italic>Escherichia coli</italic> identification</title>
<p>A total of 540 recto-anal mucosal swabs from diarrhoeic calves (&#x003C; 30 days of age) were collected over 1 year from November 2015 to November 2016.</p>
<p>These calves were raised on 33 farms from eight geographic areas in Fars Province, including industrial, semi-industrial and traditional farms, with a herd size of 25&#x2013;500 cows. These farms had a recognised scouring problem in neonatal calves. Sick calves which showed abnormal faecal consistency and/or signs of dehydration and weakness were selected. None of them had been vaccinated. All samples were immediately placed in cooled boxes and transported to the laboratory. The swab samples were incubated overnight at 37 <italic>&#x00B0;</italic>C in trypticase soy broth (TSB) (Merck KgaA, Darmstadt, Germany). Each sample was then streaked onto MacConkey&#x2019;s agar (MC, Merck, Germany) (24 hours at 37 &#x00B0;C). Lactose positive colonies were cultured on eosin methylene blue agars (EMB, Merck, Germany) (24 h at 37 &#x00B0;C). Green colonies with a metallic lustre were considered typical <italic>E. coli</italic> colonies. Such colonies were confirmed as <italic>E. coli</italic> using standard biochemical tests (citrate utilisation, indole production, glucose, lactose fermentation, urease negative and hydrogen sulphate production). The biochemically confirmed <italic>E. coli</italic> colonies were subjected to DNA analysis.</p>
</sec>
<sec id="s30005">
<title>Antimicrobial susceptibility and multidrug resistance</title>
<p>Antimicrobial susceptibility testing against eight antimicrobials was performed on 52 O157 and 12 non-O157 STEC isolates using the disk diffusion method on Mueller Hinton agar plates (Merck, Germany) based on the Clinical and Laboratory Standards Institute (CLSI) guidelines (Wayne <xref ref-type="bibr" rid="CIT0042">2012a</xref>). The following antibiotics (PadtanTeb, Iran) were applied: chloramphenicol (C: 30 <italic>&#x00B5;</italic>g), erythromycin (E: 25 <italic>&#x00B5;</italic>g), ampicillin (AM: 10 <italic>&#x00B5;</italic>g), trimethoprim/sulfamethoxazole (SXT: 30 <italic>&#x00B5;</italic>g), penicillin (P: 10 <italic>&#x00B5;</italic>g), enrofloxacin (ENR: 10 <italic>&#x00B5;</italic>g), cefixime (CFM: 5 <italic>&#x00B5;</italic>g) and tetracycline (TET: 30 <italic>&#x00B5;</italic>g). The zone diameters were measured (to the nearest millimetre) and interpreted as intermediate (I), susceptible (S) or resistant (R) according to CLSI protocol (Wayne <xref ref-type="bibr" rid="CIT0042">2012a</xref>); intermediate strains were considered susceptible. Based on the definition proposed by an international expert, the MDR phenotype was resistant to three or more antimicrobial classes (Magiorakos et al. <xref ref-type="bibr" rid="CIT0017">2012</xref>). <italic>E. coli, ATCC 25922</italic> (sensitive to all these drugs), recommended by CLSI, was used as a quality control. The specified range of quality control result was published in M100-S22 (Wayne <xref ref-type="bibr" rid="CIT0043">2012b</xref>).</p>
</sec>
<sec id="s30006">
<title>DNA extraction</title>
<p>A single colony of overnight TSB culture was suspended in 100 <italic>&#x00B5;</italic>L of distilled water and exposed to boiling for 10 min at 100 &#x00B0;C. After a 13 min freeze, the frozen cell pellets were centrifuged at 14 000 rpm for 10 min (Dehkordi et al. <xref ref-type="bibr" rid="CIT0008">2014</xref>) and the supernatant, containing bacterial DNA, was subjected to PCR analysis.</p>
</sec>
<sec id="s30007">
<title>Polymerase chain reaction detection of virulence factors and class 1 integron in Shiga toxin-producing <italic>Escherichia coli</italic> strains</title>
<p>Polymerase chain reaction assays were used to detect the presence of the following virulence genes coding regions including <italic>stx1, stx2</italic> and <italic>eae</italic>. To detect class 1 integron in confirmed STEC isolates, a PCR protocol was employed. Preparation of the DNA samples was done as described in previously published paper (Dehkordi et al. <xref ref-type="bibr" rid="CIT0008">2014</xref>). Primer sequences, sizes of PCR products and PCR conditions are shown in <xref ref-type="table" rid="T0001">Table 1</xref>. DNA from <italic>E. coli</italic> O157:H7 EDL933 strain and <italic>ATCC 25922</italic> strains were used as positive and negative controls, respectively. The amplified DNA products were separated by 1.5&#x0025; agarose gel electrophoresis (Sigma-Aldrich, St. Louis, MO, United States). The gels were stained with ethidium bromide (Merek, Germany). Visualisation of amplified products was done by ultraviolet (UV) illumination and photographed using a Kodak camera system (Gel Logic 200).</p>
<table-wrap id="T0001">
<label>TABLE 1</label>
<caption><p>Primers and polymerase chain reaction conditions used in this study.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left">Gene</th>
<th valign="top" align="left">Primer sequence</th>
<th valign="top" align="center">Size of product (bp)</th>
<th valign="top" align="left">PCR programme</th>
<th valign="top" align="left">PCR volume (25 <italic>&#x03BC;</italic>L)</th>
<th valign="top" align="left">Reference</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left"><italic>stx1</italic></td>
<td align="left">F: CTT CGG TAT CCT ATT CCC GG<break/>R: GGA TGC ATC TCT GGT CAT TG</td>
<td align="center">484</td>
<td align="left">25 cycles of 30 s at 94 &#x00B0;C<break/>45 s at 50 &#x00B0;C<break/>90 s at 70 &#x00B0;C<break/>10 min at 70 &#x00B0;C</td>
<td align="left">2.5 <italic>&#x03BC;</italic>L PCR buffer 10X<break/>1.25 <italic>&#x03BC;</italic>L MgCl<sub>2</sub><break/>0.5 <italic>&#x03BC;</italic>LdNTP<break/>1 <italic>&#x03BC;</italic>L of each primers F &#x0026; R<break/>0.25 <italic>&#x03BC;</italic>LTaq DNA polymerase<break/>1 <italic>&#x03BC;</italic>L DNA template</td>
<td align="left">Tahamtan et al. (<xref ref-type="bibr" rid="CIT0036">2010</xref>)</td>
</tr>
<tr>
<td align="left"><italic>stx2</italic></td>
<td align="left">F: CCA TGA CAA CGG ACA GCA GTT<break/>R: CCT GTC AAC TGA GCA GCA CTT TG</td>
<td align="center">779</td>
<td align="left">25 cycles of 30 s at 94 &#x00B0;C<break/>45 s at 50 &#x00B0;C<break/>90 s at 70 &#x00B0;C<break/>10 min at 70 &#x00B0;C</td>
<td align="left">2.5 <italic>&#x03BC;</italic>L PCR buffer 10X<break/>1.25 <italic>&#x03BC;</italic>L MgCl<sub>2</sub><break/>0.5 <italic>&#x03BC;</italic>LdNTP<break/>1 <italic>&#x03BC;</italic>L of each primers F &#x0026; R<break/>0.25 <italic>&#x03BC;</italic>LTaq DNA polymerase<break/>1 <italic>&#x03BC;</italic>L DNA template</td>
<td align="left">Tahamtan et al. (<xref ref-type="bibr" rid="CIT0036">2010</xref>)</td>
</tr>
<tr>
<td align="left"><italic>eae</italic></td>
<td align="left">F: AAG CGA CTG AGG TCA CT<break/>R: ACG CTG CTC ACT AGA TGT</td>
<td align="center">384</td>
<td align="left">25 cycles of 30 s at 94 &#x00B0;C<break/>45 s at 50 &#x00B0;C<break/>90 s at 70 &#x00B0;C<break/>10 min at 70 &#x00B0;C</td>
<td align="left">2.5 <italic>&#x03BC;</italic>L PCR buffer 10X<break/>1.25 <italic>&#x03BC;</italic>L MgCl<sub>2</sub><break/>0.5 <italic>&#x03BC;</italic>LdNTP<break/>1 <italic>&#x03BC;</italic>L of each primers F &#x0026; R<break/>0.25 <italic>&#x03BC;</italic>LTaq DNA polymerase<break/>1 <italic>&#x03BC;</italic>L DNA template</td>
<td align="left">Vasconcellos et al. (<xref ref-type="bibr" rid="CIT0040">2012</xref>)</td>
</tr>
<tr>
<td align="left"><italic>IntI</italic></td>
<td align="left">F: TGCGGGTYAARGATBTKGATTT*<break/>R: CARCACATGCGTRTARAT</td>
<td align="center">491</td>
<td align="left">30 s at 94 &#x00B0;C, 35 s at 57 &#x00B0;C<break/>25 cycles of 1 min at 70 &#x00B0;C 10 min at 72 &#x00B0;C</td>
<td align="left">2.5 <italic>&#x03BC;</italic>L PCR buffer X 10<break/>1.25 <italic>&#x03BC;</italic>L MgCl<sub>2</sub><break/>1 <italic>&#x03BC;</italic>LdNTP<break/>1 <italic>&#x03BC;</italic>L of each primers F &#x0026; R<break/>0.25 <italic>&#x03BC;</italic>LTaq DNA polymerase<break/>1 <italic>&#x03BC;</italic>l DNA template</td>
<td align="left">Tahamtan et al. (<xref ref-type="bibr" rid="CIT0035">2014</xref>)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn><p>Note: B = C or G or T; K = G or T; R = A or G; Y = C or T*.</p></fn>
<fn><p>PCR, polymerase chain reaction; DNA, deoxyribonucleic acid; Taq, thermus aquaticus; <italic>stx</italic>, isolates carrying <italic>stx1</italic> and/or <italic>stx2</italic> genes; <italic>eae</italic>, isolates carrying <italic>eae</italic> gene; pb, base pair; <italic>IntI</italic>, encoded integrases.</p></fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="s30008">
<title>Statistical analysis</title>
<p>The chi-square (&#x03C7;<sup>2</sup>) test and Fisher&#x2019;s exact test were used to assess whether integron-positive strains were significantly more resistant than integron-negative strains for each of the tested antibiotics. A <italic>p</italic> value &#x003C; 0.05 was considered statistically significant. Statistical calculations were made using GraphPad Prism for Windows version 5 (GraphPad Software, San Diego, CA).</p>
</sec>
</sec>
</sec>
<sec id="s0009">
<title>Results</title>
<sec id="s20010">
<title>Isolation and characterisation of Shiga toxin-producing <italic>Escherichia coli</italic> in calves</title>
<p>From 540 diarrhoeic calves, 312 samples (57.7&#x0025;) were positive for <italic>E. coli</italic>. Shiga toxin&#x2013;producing <italic>Escherichia coli</italic> strains were isolated from 71 (22.7&#x0025;) out of the 312 samples, which possess <italic>stx1</italic> and/or <italic>stx2</italic>. Twelve (3.57&#x0025;) isolates were classified as <italic>E. coli</italic> O157:H7 and 59 (31.19&#x0025;) as non-O157.</p>
</sec>
<sec id="s20011">
<title>Characterisation of virulence genes</title>
<p>Of 312 <italic>E. coli</italic> strain<italic>s</italic>, 71 isolates (22.7&#x0025;) were identified as STEC. The virulence genes <italic>stx2, stx1</italic> and <italic>eae</italic> were detected at 76&#x0025;, 46.4&#x0025; and 53.5&#x0025; in STEC isolates, respectively. Of isolates that were not characterised as STEC, 101 (32.3&#x0025;) were positive for <italic>eae</italic> gene (<xref ref-type="fig" rid="F0001">Figures 1</xref> and <xref ref-type="fig" rid="F0002">2</xref>). These findings are summarised in <xref ref-type="table" rid="T0002">Table 2</xref>. Out of 59 non-O157 strains (PNU6, PNU11, PNU12 and PNU16) in the diarrhoeic calves, four were positive for both the <italic>stx1</italic> and <italic>stx2</italic> genes and three non-O157 harboured all of the <italic>stx1, stx2</italic> and <italic>eae</italic> genes.</p>
<table-wrap id="T0002">
<label>TABLE 2</label>
<caption><p>Distribution of virulence genes in Shiga toxin-producing <italic>Escherichia coli</italic> strains.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left" rowspan="3">Pathotype</th>
<th valign="top" align="left" rowspan="3">Serogroup</th>
<th valign="top" align="center" colspan="2">Positive sample<hr/></th>
<th valign="top" align="center" colspan="14">Number of isolates carrying specific genes<hr/></th>
</tr>
<tr>
<th valign="top" align="center" rowspan="2">No.</th>
<th valign="top" align="center" rowspan="2">&#x0025;</th>
<th valign="top" align="center" colspan="2"><italic>stx1</italic><hr/></th>
<th valign="top" align="center" colspan="2"><italic>stx2</italic><hr/></th>
<th valign="top" align="center" colspan="2"><italic>eae</italic><hr/></th>
<th valign="top" align="center" colspan="2"><italic>stx2/stx1</italic><hr/></th>
<th valign="top" align="center" colspan="2"><italic>stx1/eae</italic><hr/></th>
<th valign="top" align="center" colspan="2"><italic>stx2/eae</italic><hr/></th>
<th valign="top" align="center" colspan="2"><italic>stx1/stx2/eae</italic><hr/></th>
</tr>
<tr>
<th valign="top" align="center">No.</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">No.</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">No.</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">No.</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">No.</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">No.</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">No.</th>
<th valign="top" align="center">&#x0025;</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left" rowspan="2">STEC</td>
<td align="left">Non-O157</td>
<td align="center">59</td>
<td align="center">100.0</td>
<td align="center">21</td>
<td align="center">36</td>
<td align="center">41</td>
<td align="center">70</td>
<td align="center">26</td>
<td align="center">44.0</td>
<td align="center">3</td>
<td align="center">5.0</td>
<td align="center">10</td>
<td align="center">16.9</td>
<td align="center">13</td>
<td align="center">22.0</td>
<td align="center">3</td>
<td align="center">5.0</td>
</tr>
<tr>
<td align="left">O157</td>
<td align="center">12</td>
<td align="center">-</td>
<td align="center">12</td>
<td align="center">-</td>
<td align="center">12</td>
<td align="center">-</td>
<td align="center">12</td>
<td align="center">-</td>
<td align="center">0</td>
<td align="center">-</td>
<td align="center">0</td>
<td align="center">-</td>
<td align="center">0</td>
<td align="center">-</td>
<td align="center">12</td>
<td align="center">-</td>
</tr>
<tr>
<td align="left">Total STEC</td>
<td align="left"></td>
<td align="center">71</td>
<td align="center">100.0</td>
<td align="center">33</td>
<td align="center">46</td>
<td align="center">53</td>
<td align="center">75</td>
<td align="center">38</td>
<td align="center">54</td>
<td align="center">3</td>
<td align="center">4.2</td>
<td align="center">10</td>
<td align="center">14.0</td>
<td align="center">13</td>
<td align="center">18.3</td>
<td align="center">15</td>
<td align="center">21.1</td>
</tr>
<tr>
<td align="left">Non-STEC</td>
<td align="left"></td>
<td align="center">241</td>
<td align="center">-</td>
<td align="center">-</td>
<td align="center">-</td>
<td align="center">-</td>
<td align="center">-</td>
<td align="center">63</td>
<td align="center">-</td>
<td align="center">-</td>
<td align="center">-</td>
<td align="center">-</td>
<td align="center">-</td>
<td align="center">-</td>
<td align="center">-</td>
<td align="center">-</td>
<td align="center">-</td>
</tr>
<tr>
<td align="left">Total</td>
<td align="left"></td>
<td align="center">312</td>
<td align="center">100.0</td>
<td align="center">33</td>
<td align="center">11</td>
<td align="center">53</td>
<td align="center">17.0</td>
<td align="center">101</td>
<td align="center">32</td>
<td align="center">3</td>
<td align="center">0.9</td>
<td align="center">10</td>
<td align="center">3.2</td>
<td align="center">13</td>
<td align="center">4.1</td>
<td align="center">15</td>
<td align="center">4.8</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn><p>Overall: STEC, 71 (22.7&#x0025;); Non-STEC, 241 (77.3&#x0025;).</p></fn>
<fn><p>Overall: Non-O157, 52 (16.6&#x0025;); O157, 12 (3.8&#x0025;).</p></fn>
<fn><p>STEC, Shiga toxin-producing <italic>Escherichia coli</italic>; No., number; <italic>stx</italic>, isolates carrying <italic>stx1</italic> and/or <italic>stx2</italic> genes; <italic>eae</italic>, isolates carrying <italic>eae</italic> gene.</p></fn>
<fn><p>Note: The <italic>eae</italic> gene produces a 94-kDa outer membrane protein called intimin.</p></fn>
</table-wrap-foot>
</table-wrap>
<fig id="F0001">
<label>FIGURE 1</label>
<caption><p>Agarose gels electerophoresis of Shiga toxin-producing <italic>Escherichia coli</italic> isolates. (a) Polymerase chain reaction amplification of the <italic>stx1</italic> (551 bp) and <italic>stx2</italic> (118 bp) genes. Lanes 1&#x2013;3, <italic>stx1</italic>; lanes 1&#x2013;3 and 5, <italic>stx2</italic> and (b) polymerase chain reaction amplification of the <italic>eae</italic> gene (840 bp) (lanes 1&#x2013;4, 6 and 7). Lane M, 100 bp molecular size markers; Lanes C- and C+, negative and positive control.</p></caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="OJVR-85-1621-g001.tif"/>
</fig>
<fig id="F0002">
<label>FIGURE 2</label>
<caption><p>Frequency of occurrence of tested virulence genes in 71 STEC strains.</p></caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="OJVR-85-1621-g002.tif"/>
</fig>
</sec>
<sec id="s20012">
<title>Antibiotic susceptibility</title>
<p>The antimicrobial susceptibility of 52 non-O157 and 12 O157 STEC isolates was determined by the disk diffusion method. The resistance patterns of the <italic>E. coli</italic> O157 strains were to penicillin and ampicillin (91&#x0025; &#x2013; 8&#x0025;), followed by tetracycline, erythromycin and cefixime (66&#x0025; &#x2013; 25&#x0025;). Nine (75&#x0025;) of the 12 O157 strains exhibited multidrug resistance (MDR, resistant to &#x2265; 3 antimicrobial classes). The most common MDR phenotypes were AM-E-P-TET, which accounted for 15&#x0025; of the 12 O157 strains. All of the examined non-O157 strains showed resistance to trimethoprim/sulfamethoxazole. The resistance patterns of all non-O157 strains to tested antibiotics were as follows: erythromycin (98&#x0025;), penicillin (91&#x0025;), ampicillin (73&#x0025;), tetracycline (65&#x0025;), chloramphenicol (40&#x0025;), cefixime (25&#x0025;) and enrofloxacin (21&#x0025;). Forty-eight (92&#x0025;) of the 52 non-O157 strains displayed multidrug resistance. The most frequently observed MDR profiles AM-C-E-P-TET-ENR&#x2013;SXT (33&#x0025; of the 52 non-O157 strains) were associated with 10 of these isolates (PNU4, PNU29, PNU31, PNU33, PNU38, PNU41, PNU49, PNU50, PNU51, PNU52). The resistance patterns of 64 STEC isolates are shown in <xref ref-type="table" rid="T0003">Table 3</xref> and <xref ref-type="fig" rid="F0003">Figure 3</xref>.</p>
<fig id="F0003">
<label>FIGURE 3</label>
<caption><p>Antimicrobial susceptibility patterns in 71 Shiga toxin-producing <italic>Escherichia coli</italic> strains.</p></caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="OJVR-85-1621-g003.tif"/>
</fig>
<table-wrap id="T0003">
<label>TABLE 3</label>
<caption><p>Antibiotic resistance pattern in Shiga toxin&#x2013;producing <italic>Escherichia coli</italic> strains.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left" rowspan="2">STEC - Serogroup</th>
<th valign="top" align="center" colspan="2">No. positive<hr/></th>
<th valign="top" align="center" colspan="2">AM10<hr/></th>
<th valign="top" align="center" colspan="2">C30<hr/></th>
<th valign="top" align="center" colspan="2">CFM5<hr/></th>
<th valign="top" align="center" colspan="2">E25<hr/></th>
<th valign="top" align="center" colspan="2">ENR10<hr/></th>
<th valign="top" align="center" colspan="2">P10<hr/></th>
<th valign="top" align="center" colspan="2">SXT30<hr/></th>
<th valign="top" align="center" colspan="2">TET30<hr/></th>
</tr>
<tr>
<th valign="top" align="center">Sample</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">Sample</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">Sample</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">Sample</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">Sample</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">Sample</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">Sample</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">Sample</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">Sample</th>
<th valign="top" align="center">&#x0025;</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left">Non-O157</td>
<td align="center">52</td>
<td align="center">100.0</td>
<td align="center">38</td>
<td align="center">73.0</td>
<td align="center">21</td>
<td align="center">40.0</td>
<td align="center">13</td>
<td align="center">25.0</td>
<td align="center">51</td>
<td align="center">98.0</td>
<td align="center">11</td>
<td align="center">21.1</td>
<td align="center">51</td>
<td align="center">98.0</td>
<td align="center">52</td>
<td align="center">100.0</td>
<td align="center">34</td>
<td align="center">65.3</td>
</tr>
<tr>
<td align="left">O157</td>
<td align="center">12</td>
<td align="center">18.7</td>
<td align="center">10</td>
<td align="center">83.0</td>
<td align="center">0</td>
<td align="left"></td>
<td align="center">3</td>
<td align="center">25.0</td>
<td align="center">8</td>
<td align="center">66.6</td>
<td align="center">0</td>
<td align="center">-</td>
<td align="center">11</td>
<td align="center">91.6</td>
<td align="center">0</td>
<td align="left"></td>
<td align="center">8</td>
<td align="center">66.6</td>
</tr>
<tr>
<td align="left">Total STEC</td>
<td align="center">64</td>
<td align="center">100.0</td>
<td align="center">48</td>
<td align="center">75.0</td>
<td align="center">21</td>
<td align="center">32.8</td>
<td align="center">16</td>
<td align="center">25.0</td>
<td align="center">59</td>
<td align="center">92.1</td>
<td align="center">11</td>
<td align="center">17.1</td>
<td align="center">62</td>
<td align="center">96.8</td>
<td align="center">25</td>
<td align="center">39.0</td>
<td align="center">42</td>
<td align="center">65.6</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn><p>AM10, ampicillin (10 <italic>&#x00B5;</italic>g/disk); TET30, tetracycline (30 <italic>&#x00B5;</italic>g/disk); E25, erythromycin (25 <italic>&#x00B5;</italic>g/disk); ENR10, enrofloxacin (10 <italic>&#x00B5;</italic>g/disk); SXT30, trimethoprim/sulfamethoxazole (30 <italic>&#x00B5;</italic>g/disk); C30, chloramphenicol (30 <italic>&#x00B5;</italic>g/disk); P10, penicillin (10 <italic>&#x00B5;</italic>g/disk); CFM5, cefixime (5 <italic>&#x00B5;</italic>g/disk); STEC, Shiga toxin-producing <italic>Escherichia coli</italic>; No., number.</p></fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="s20013">
<title>Integrons</title>
<p>Class 1 integrons were detected among 23 (36&#x0025;) of the STEC isolates (<xref ref-type="fig" rid="F0004">Figure 4</xref> and <xref ref-type="table" rid="T0004">Table 4</xref>). Integron-positive strains were significantly more resistant to enrofloxacin, trimethoprim/sulfamethoxazole and tetracycline than integron-negative strains (<italic>p</italic> &#x003C; 0.05). Nevertheless, resistance to ampicillin, erythromycin, penicillin, cefixime and chloramphenicol could not be directly related to the presence of integrons (<xref ref-type="table" rid="T0005">Table 5</xref>). All of the integron-positive strains displayed multidrug resistance. The most prevalent MDR phenotypes in integron-positive strains were AM-CFM-E-P-TET (26&#x0025; of the 52 non-O157 strains).</p>
<fig id="F0004">
<label>FIGURE 4</label>
<caption><p>Polymerase chain reaction amplicons of Shiga toxin-producing <italic>Escherichia coli</italic> integrons. Polymerase chain reaction amplification of the class 1 integron, integrase. bp, base pair; <italic>int1</italic>, integrase gene.</p></caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="OJVR-85-1621-g004.tif"/>
</fig>
<table-wrap id="T0004">
<label>TABLE 4</label>
<caption><p>Overview of the integron-positive Shiga toxin&#x2013;producing <italic>Escherichia coli</italic> strains.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left" rowspan="2">Strain</th>
<th valign="top" align="left" rowspan="2">Serogroup</th>
<th valign="top" align="center" rowspan="2">Virulence profile <italic>stx1/2</italic> gene</th>
<th valign="top" align="center" rowspan="2">Integron <italic>int</italic> gene</th>
<th valign="top" align="center" colspan="8">Antibiotic resistance profile<hr/></th>
<th valign="top" align="center" rowspan="2">MDR</th>
</tr>
<tr>
<th valign="top" align="center">AM</th>
<th valign="top" align="center">C</th>
<th valign="top" align="center">CFM</th>
<th valign="top" align="center">E</th>
<th valign="top" align="center">ENR</th>
<th valign="top" align="center">P</th>
<th valign="top" align="center">SXT</th>
<th valign="top" align="center">TET</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left">PNU1</td>
<td align="left">Non-157</td>
<td align="center">1</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU2</td>
<td align="left">Non-157</td>
<td align="center">2</td>
<td align="center">+</td>
<td align="center">S</td>
<td align="center">S</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU3</td>
<td align="left">Non-157</td>
<td align="center">2</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU4</td>
<td align="left">Non-157</td>
<td align="center">2</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU5</td>
<td align="left">Non-157</td>
<td align="center">2</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU7</td>
<td align="left">Non-157</td>
<td align="center">1</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU10</td>
<td align="left">Non-157</td>
<td align="center">1</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU20</td>
<td align="left">O157</td>
<td align="center">1, 2</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU21</td>
<td align="left">O157</td>
<td align="center">1, 2</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU24</td>
<td align="left">O157</td>
<td align="center">1, 2</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU26</td>
<td align="left">O157</td>
<td align="center">1, 2</td>
<td align="center">+</td>
<td align="center">S</td>
<td align="center">S</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">S</td>
<td align="center">-</td>
</tr>
<tr>
<td align="left">PNU30</td>
<td align="left">Non-157</td>
<td align="center">2</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU31</td>
<td align="left">Non-157</td>
<td align="center">2</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU33</td>
<td align="left">Non-157</td>
<td align="center">1</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU34</td>
<td align="left">Non-157</td>
<td align="center">2</td>
<td align="center">+</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU35</td>
<td align="left">Non-157</td>
<td align="center">2</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU39</td>
<td align="left">Non-157</td>
<td align="center">2</td>
<td align="center">+</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU40</td>
<td align="left">Non-157</td>
<td align="center">1</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU50</td>
<td align="left">Non-157</td>
<td align="center">1</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU51</td>
<td align="left">Non-157</td>
<td align="center">2</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU58</td>
<td align="left">Non-157</td>
<td align="center">2</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU61</td>
<td align="left">Non-157</td>
<td align="center">2</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
<tr>
<td align="left">PNU62</td>
<td align="left">Non-157</td>
<td align="center">2</td>
<td align="center">+</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">S</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">R</td>
<td align="center">+</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn><p>Note: Antibiotic resistance profile was determined for eight antibiotics: ampicillin (AM), tetracycline (TET), erythromycin (E), enrofloxacin (ENR), trimethoprim/sulfamethoxazole (SXT), chloramphenicol (C), penicillin (P) and cefixime (CFM).</p></fn>
<fn><p><italic>stx</italic>, isolates carrying <italic>stx1</italic> and/or <italic>stx2</italic> genes; MDR, multidrug-resistant isolates; S, antibiotic-susceptible isolates; R, antibiotic-resistant isolates.</p></fn>
<fn><p>+, positive for <italic>int</italic> gene or MDR.</p></fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T0005">
<label>TABLE 5</label>
<caption><p>Comparison of the resistances between integron-positive and integron-negative strains was done using the <italic>p</italic>-values listed in the table.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left" rowspan="2">Antibiotic</th>
<th valign="top" align="center" colspan="2">Resistance <italic>int</italic>-positive isolates<hr/></th>
<th valign="top" align="center" colspan="2">Resistance <italic>int</italic>-negative isolates<hr/></th>
<th valign="top" align="center" colspan="2">Resistance of total isolates<hr/></th>
<th valign="top" align="center" rowspan="2">Association with integron</th>
</tr>
<tr>
<th valign="top" align="center">No.</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">No.</th>
<th valign="top" align="center">&#x0025;</th>
<th valign="top" align="center">No.</th>
<th valign="top" align="center">&#x0025;</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left">Ampicillin</td>
<td align="center">19</td>
<td align="center">29.6</td>
<td align="center">28</td>
<td align="center">42.2</td>
<td align="center">47</td>
<td align="center">71.8</td>
<td align="center">0.2523</td>
</tr>
<tr>
<td align="left">Erythromycin</td>
<td align="center">23</td>
<td align="center">35.9</td>
<td align="center">39</td>
<td align="center">60.9</td>
<td align="center">62</td>
<td align="center">96.8</td>
<td align="center">0.5322</td>
</tr>
<tr>
<td align="left">Penicillin</td>
<td align="center">22</td>
<td align="center">34.3</td>
<td align="center">40</td>
<td align="center">62.5</td>
<td align="center">62</td>
<td align="center">96.8</td>
<td align="center">1.0000</td>
</tr>
<tr>
<td align="left">Tetracycline</td>
<td align="center">21</td>
<td align="center">32.8</td>
<td align="center">20</td>
<td align="center">29.6</td>
<td align="center">41</td>
<td align="center">62.5</td>
<td align="center">0.0009<xref ref-type="table-fn" rid="TFN0001">*</xref></td>
</tr>
<tr>
<td align="left">Trimethoprim/sulfamethoxazole</td>
<td align="center">15</td>
<td align="center">23.4</td>
<td align="center">10</td>
<td align="center">15.6</td>
<td align="center">15</td>
<td align="center">39.00</td>
<td align="center">0.0032<xref ref-type="table-fn" rid="TFN0001">*</xref></td>
</tr>
<tr>
<td align="left">Cefixime</td>
<td align="center">7</td>
<td align="center">10.9</td>
<td align="center">9</td>
<td align="center">14.1</td>
<td align="center">16</td>
<td align="center">25.00</td>
<td align="center">0.6521</td>
</tr>
<tr>
<td align="left">Enrofloxacin</td>
<td align="center">7</td>
<td align="center">10.9</td>
<td align="center">4</td>
<td align="center">6.2</td>
<td align="center">11</td>
<td align="center">17.1</td>
<td align="center">0.0456<xref ref-type="table-fn" rid="TFN0001">*</xref></td>
</tr>
<tr>
<td align="left">Chloramphenicol</td>
<td align="center">10</td>
<td align="center">15.6</td>
<td align="center">11</td>
<td align="center">17.1</td>
<td align="center">21</td>
<td align="center">32.8</td>
<td align="center">0.2780</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn><p>Note: <italic>p</italic> values of 0.05 were considered to be significant.</p></fn>
<fn><p><italic>int</italic>-positive, integron-positive in PCR assay; <italic>int</italic>-negative, integron-negative in PCR assay.</p></fn>
<fn><p><italic>int</italic>, integron; No., number.</p></fn>
<fn id="TFN0001"><label>*</label><p>, Correlation is significant at the 0.05 level.</p></fn>
</table-wrap-foot>
</table-wrap>
</sec>
</sec>
<sec id="s0014">
<title>Discussion</title>
<p>Antibiotic resistance developed in STEC isolates from humans and animals (Van Meervenne et al. <xref ref-type="bibr" rid="CIT0039">2013</xref>). Integrons, which are known to be associated with many antimicrobial resistance genes, were suspected to serve as pools of antimicrobial resistance genes worldwide (El-Sokkary &#x0026; Abdelmegeed <xref ref-type="bibr" rid="CIT0011">2015</xref>). Class 1 integrons are commonly found in gram-negative pathogens (Maguire et al. <xref ref-type="bibr" rid="CIT0018">2001</xref>).</p>
<p>In this study, the presence of major virulence factors and resistance to antimicrobials belonging to classes generally utilised in Iran was investigated in zoonotic STEC isolates from calves with diarrhoea. Owing to the close contact of humans with animals, the presence of virulence and antimicrobial resistance genes in <italic>E. coli</italic> strains harboured by animals leads to public health concerns (Torkan et al. <xref ref-type="bibr" rid="CIT0038">2016</xref>). <italic>Escherichia coli,</italic> which has been implicated as an aetiological factor of calf diarrhoea, harbours many virulence genes that enable it to cause disease in a particular host (Nagarjuna et al. <xref ref-type="bibr" rid="CIT0024">2015</xref>). In the present study, among 312 <italic>E. coli</italic> strains from diarrhoeic calves, 71 (22.7&#x0025;) were STEC. The results are in agreement with those of Dastmalchi et al. (<xref ref-type="bibr" rid="CIT0007">2012</xref>), who screened 51 <italic>E. coli</italic> isolates from diarrhoeic calves in the Urmia region, which is located in west Azerbaijan Province, Iran, and illustrated that 19.6&#x0025; of isolates were <italic>stx</italic> positive. Most epidemiological studies in diarrhoeic calves in Iran have disclosed that the prevalence of STEC infection ranges between 6.4&#x0025; and 34.5&#x0025; (Pourtaghi, Dahpahlavan &#x0026; Momtaz <xref ref-type="bibr" rid="CIT0028">2013</xref>; Shahrani et al. <xref ref-type="bibr" rid="CIT0033">2014</xref>). These discrepancies can be attributed to the small sample size and geographical differences. In other words, STEC prevalence in calves may be influenced by environmental factors (Dastmalchi et al. <xref ref-type="bibr" rid="CIT0007">2012</xref>). Higher prevalence of the <italic>stx2</italic> gene (54 isolates) compared to the <italic>stx1</italic> gene (33 isolates) in this study corroborates the findings of previous reports in Iran (Dastmalchi et al. <xref ref-type="bibr" rid="CIT0007">2012</xref>; Tahamtan, Hayati &#x0026; Namavari <xref ref-type="bibr" rid="CIT0036">2010</xref>). However, these results contrast with other reports that have shown that most STEC from diarrhoeic calves only produce <italic>stx1</italic>, whereas <italic>stx2</italic>-positive strains are the dominant types in healthy calves (Nguyen, Vo &#x0026; Vu-Khac <xref ref-type="bibr" rid="CIT0026">2011</xref>). The differences in these findings suggest that <italic>stx2</italic> may be associated with a majority of <italic>E. coli</italic> isolates from diarrhoeic calves in Iran. Shiga toxin producing <italic>E. coli</italic> infection, which is associated with diarrhoea in calves, may result in severe diseases in humans such as HUS and HC (Bastos et al. <xref ref-type="bibr" rid="CIT0004">2006</xref>). The diarrhoeal phase of diseases associated with STEC is usually self-limiting, and the role of early antimicrobial treatment in the prevention of HUS is still regarded as controversial (Shahrani et al. <xref ref-type="bibr" rid="CIT0033">2014</xref>). Current recommendations and the available data suggest that not only do antibiotic exposure increase the risk of HUS in children via inducing expression of <italic>stx</italic> through replication of temperate <italic>bacteriophages</italic> carrying <italic>stx</italic>-encoding <italic>genes</italic> (Ochoa et al. <xref ref-type="bibr" rid="CIT0027">2007</xref>), it turns out to have another perilous effect on the frequency of STEC antimicrobial resistance (Shahrani et al. <xref ref-type="bibr" rid="CIT0033">2014</xref>), which could result in an increase of frequency of STEC and perhaps greater shedding. Resistance could contribute to <italic>g</italic>reater contamination of animal food products with STEC (Torkan et al. <xref ref-type="bibr" rid="CIT0038">2016</xref>). Several reports have documented that a significant increase of antimicrobial resistance in STEC strains isolated from animals and humans has acquired antibiotic resistance genes almost 20 years ago (Zhao et al. <xref ref-type="bibr" rid="CIT0045">2001</xref>). In STEC strains, class 1 integrons are strongly associated with multidrug resistance (Colello et al. <xref ref-type="bibr" rid="CIT0006">2015</xref>). Previous studies have reported the occurrence and prevalence of class 1 integrons to be ranging from 2.7&#x0025; to 41.0&#x0025; among STEC isolates in Germany (Askar et al. <xref ref-type="bibr" rid="CIT0001">2011</xref>), Argentina (Colello et al. <xref ref-type="bibr" rid="CIT0006">2015</xref>), Belgium (Van Meervenne et al. <xref ref-type="bibr" rid="CIT0039">2013</xref>), North America (Nagachinta &#x0026; Chen <xref ref-type="bibr" rid="CIT0023">2009</xref>), Brazil (Cergole-Novella et al. <xref ref-type="bibr" rid="CIT0005">2011</xref>) and US (Singh et al. <xref ref-type="bibr" rid="CIT0034">2005</xref>; Zhao et al. <xref ref-type="bibr" rid="CIT0045">2001</xref>). Class 1 integrons appear to be common in the endemic STEC strains. In the present study, class 1 integron was identified in 23 (36&#x0025;) out of 71 STEC isolates. Our data revealed low distribution of class 1 integrons among STEC isolates from calves with diarrhoea in the south of Iran compared with a similar study in northern Iran in 2014 for which the authors found a higher percentage (53&#x0025;) of the strains containing integron class 1 (Bakhshi et al. <xref ref-type="bibr" rid="CIT0002">2014</xref>). The various percentages of class 1 integrons in different parts of the world could be attributed to the characteristics of the analysed collection and differences in the prevalence of antibiotic consumption in each country (Kargar et al. <xref ref-type="bibr" rid="CIT0016">2014</xref>). In general, exposure to antibiotics, heavy metals or biocides and a high multiplicity of other different environmental factors are among the main reasons for an increase of cells containing integrons (Baquero, Mart&#x00ED;nez &#x0026; Cant&#x00F3;n <xref ref-type="bibr" rid="CIT0003">2008</xref>).</p>
<p>All integron-positive strains examined in this study were resistant to at least three different antibiotics (MDR). Similarly, high percentages of MDR phenotypes among integron-positive STEC strains have been reported in Argentina (Nagachinta &#x0026; Chen <xref ref-type="bibr" rid="CIT0023">2009</xref>) and Iran (Bakhshi, Najibi &#x0026; Sepehri-Seresht <xref ref-type="bibr" rid="CIT0002">2014</xref>). However, other authors (Colello et al. <xref ref-type="bibr" rid="CIT0006">2015</xref>; Van Meervenne et al. <xref ref-type="bibr" rid="CIT0039">2013</xref>) have reported a lower rate (less than 90&#x0025;) of STEC in diarrhoeic calves. The highest resistances among the integron-positive strains were found to enrofloxacin (17&#x0025;), trimethoprim/sulfamethoxazole (39&#x0025;) and tetracycline (62&#x0025;). The integron-positive strains were significantly more resistant to these antibiotics than the integron-negative strains. The resistance to enrofloxacin (ENR), trimethoprim/sulfamethoxazole (SXT) and tetracycline (TET) is related to the presence of the integron. The significant association between resistance to fluoroquinolones, tetracycline, trimethoprim and sulfonamides (ENR, TET, SXT) tested and integron existence could be explained because of the fact that many fluoroquinolone, tetracycline, trimethoprim and sulfonamide resistant genes have been reported within integron structures, including <italic>gyrA, gyrB, qnr, tetA, tetB, tetC, tetD, sul1, sul2, sul3</italic> and <italic>dfrA1</italic> (Kaplan et al. <xref ref-type="bibr" rid="CIT0015">2013</xref>; Wang et al. <xref ref-type="bibr" rid="CIT0041">2010</xref>).</p>
</sec>
<sec id="s0015">
<title>Conclusion</title>
<p>We report the presence of class 1 integrons in the most familiar STEC strains from diarrhoeic calves. Results imply that <italic>stx2, stx1</italic> and <italic>eae</italic> putative virulence gene, the <italic>IntI</italic> integrase gene and resistance to erythromycin, penicillin, ampicillin, tetracycline and trimethoprim/sulfamethoxazole were the most commonly detected characteristics of the STEC strains isolated from diarrhoeic calves in southern Iran. Our investigation demonstrated that calves are possible reservoirs of STEC strains and developed resistance to multiple classes of antimicrobials. Emerging data suggest an association between MDR and integrons which may play a significant role in the dissemination of resistance genes. Therefore, it is advised to stop routine antimicrobial treatment and conduct further molecular studies to detect other antimicrobial resistance and virulent genes in STEC isolates obtained in this study.</p>
</sec>
</body>
<back>
<ack>
<title>Acknowledgements</title>
<sec id="s20016" sec-type="COI-statement">
<title>Competing interests</title>
<p>The authors declare that they have no financial or personal relationships which may have inappropriately influenced them in writing this paper.</p>
</sec>
<sec id="s20017">
<title>Authors&#x2019; contributions</title>
<p>M.K. contributed to culture, DNA extraction, PCR techniques, analysis of results, statistical analysis and writing of the manuscript. A.G. carried out writing and revision of the manuscript. Both authors read and approved the final manuscript.</p>
</sec>
</ack>
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<fn><p><bold>How to cite this article:</bold> Kohansal, M. &#x0026; Ghanbari Asad, A., 2018, &#x2018;Molecular analysis of Shiga toxin-producing <italic>Escherichia coli</italic> O157:H7 and non-O157 strains isolated from calves&#x2019;, <italic>Onderstepoort Journal of Veterinary Research</italic> 85(1), a1621. <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.4102/ojvr.v85i1.1621">https://doi.org/10.4102/ojvr.v85i1.1621</ext-link></p></fn>
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