Molecular Typing and Antibiotic Resistance of Uropathogens in Patients with Non-Alcoholic Fatty Liver Disease and Urinary Tract Infections

Background: Urinary tract infections (UTIs) are among the most common bacterial infections, with Escherichia coli being the predominant pathogen. Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized as a comorbidity associated with systemic immune dysfunction that may predispose patients to infections, including UTIs. Objective: This study evaluated the microbiological features, antibiotic resistance profiles, and molecular characteristics of uropathogens isolated from female patients with NAFLD, UTI, and NAFLD+UTI compared with healthy controls. Methodology: A total of 200 females were divided into four groups (n=50 each): NAFLD, UTI, NAFLD+UTI, and healthy controls. Urine samples were analyzed by culture, Gram stain, and biochemical testing. Antimicrobial susceptibility was determined using the VITEK® 2 system and Kirby-Bauer method. PCR confirmed E. coli isolates and screened virulence genes (fimH, papC, aer, cnf1, hlyA, afa). Clonal diversity was assessed by ERIC-PCR. Results: E. coli was the predominant isolate, especially in the NAFLD+UTI group (66%), followed by Klebsiella pneumoniae and Proteus mirabilis. High resistance rates were observed against ampicillin (82%) and trimethoprim-sulfamethoxazole (68%), while susceptibility to imipenem (100%) and nitrofurantoin (88%) remained high. Virulence genes were frequent, with fimH (96%), aer (47%), and papC (36%) predominating. ERIC-PCR revealed marked heterogeneity, with NAFLD+UTI isolates showing the greatest genetic diversity. Conclusion: NAFLD appears to increase the risk and complexity of UTIs by facilitating colonization with multidrug-resistant, virulent Gram-negative bacteria. Molecular typing confirmed E. coli as the principal pathogen, highlighting the importance of surveillance, targeted antibiotic stewardship, and consideration of metabolic comorbidities in UTI management.