Population structure, antimicrobial resistance, and virulence factors of diabetic foot-associated E. coli

Ajumobi, V., Tahir, Z., Hayes, P.M., McCormick, A.L. and Torraca, V. 2026. Population structure, antimicrobial resistance, and virulence factors of diabetic foot-associated E. coli. Microbiology Spectrum. 14 (2) e02837-25. https://doi.org/10.1128/spectrum.02837-25

TitlePopulation structure, antimicrobial resistance, and virulence factors of diabetic foot-associated E. coli
TypeJournal article
AuthorsAjumobi, V., Tahir, Z., Hayes, P.M., McCormick, A.L. and Torraca, V.
Abstract

Diabetic foot infections (DFI) are a major complication of diabetes, often leading to lower limb amputations. Escherichia coli is a predominant Gram-negative pathogen in DFI, yet its genomic and pathogenic features remain poorly characterised. Here, we present a whole genome sequence-based analysis of diabetic foot-associated E. coli (DFEC) isolates from diverse geographical locations. Phylogenetic reconstruction revealed substantial diversity, with strains spanning seven phylogroups and 28 sequence types. Capsule biosynthesis loci linked to invasive infections, such as K1, K2ab, and K5, were also detected. The DFEC pangenome comprised 18,263 gene clusters, indicating high genomic plasticity. The plasmid repertoire was also varied
and contributed to the genomic diversity of the strains. Approximately 78% of isolates were multidrug-resistant (MDR) or extensively drug-resistant (XDR), with resistance to last-resort antibiotics such as colistin and carbapenems also observed. High frequencies of virulence factors involved in host cell adherence, iron metabolism, serum survival, as well as toxins and type 3 secretion system (T3SS) genes were also detected. In contrast, metabolic modelling showed
conserved biochemical profiles. Clustering based on accessory metabolic functions did not mirror phylogeny, suggesting metabolic convergence among distinct lineages. Collectively, these findings reveal that DFEC are versatile pathogens with a repertoire of antimicrobial resistance and virulence determinants. These traits make them functionally distinct from commensal E. coli strains and highlight the potential of DFEC to cause severe and invasive infections.

KeywordsDiabetic foot infection, Escherichia coli, DFEC, ExPEC, multidrug resistance, whole genome sequencing
Article numbere02837-25
JournalMicrobiology Spectrum
Journal citation14 (2)
ISSN2165-0497
Year2026
PublisherAmerican Society for Microbiology
Publisher's version
License
CC BY 4.0
File Access Level
Open (open metadata and files)
Digital Object Identifier (DOI)https://doi.org/10.1128/spectrum.02837-25
Publication dates
Published online13 Jan 2026

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R. L. Goodall, D. T. Dunn, T. Pattery, A. van Cauwenberge, P. Nkurunziza, P. Awio, N. Ndembi, P. Munderi, C. Kityo, C. F. Gilks, P. Kaleebu, D. Pillay, P. Kaleebu, D. Pillay, P. Awio, M. Chirara, D. Dunn, D. M. Gibb, C. Gilks, R. Goodall, A. Kapaata, M. Katuramur, F. Lyagoba, R. Magala, B. Magambo, K. Mataruka, A.L. McCormick, L. Mugarura, T. Musunga, M. Nabankkema, J. Nkalubo, P. Nkurunziza, C. Parry, V. Robertson, M. Spyer, D. Yirrell, H. Grosskurth, P. Munderi, G. Kabuye, D. Nsibambi, R. Kasirye, E. Zalwango, M. Nakazibwe, B. Kikaire, G. Nassuna, R. Massa, K. Fadhiru, M. Namyalo, A. Zalwango, L. Generous and P. Khauka 2014. Phenotypic and genotypic analyses to guide selection of reverse transcriptase inhibitors in second-line HIV therapy following extended virological failure in Uganda. Journal of Antimicrobial Chemotherapy. 69 (7), pp. 1938-1944. https://doi.org/10.1093/jac/dku052

Feasibility of testing and detection of HIV-1 drug resistance in proviral DNA
Booth, C., McCormick, A.L., Garcia-Diaz, A., Macartney, M., Youle, M., Johnson, M. and Webster, D. 2014. Feasibility of testing and detection of HIV-1 drug resistance in proviral DNA. BMC Infectious Diseases. 14 (Supplement 4) O25. https://doi.org/10.1186/1471-2334-14-s4-o25

Analysis of transmitted HIV-1 drug resistance using 454 ultra-deep-sequencing and the DeepChek(®)-HIV system.
Garcia-Diaz, A., McCormick, A.L., Booth, C., Gonzalez, D., Sayada, C., Haque, T., Johnson, M. and Webster, D. 2014. Analysis of transmitted HIV-1 drug resistance using 454 ultra-deep-sequencing and the DeepChek(®)-HIV system. Journal of the International AIDS Society. 17 (Suppl 3) 19752. https://doi.org/10.7448/ias.17.4.19752

Macrophage-pathogen interactions in infectious diseases: new therapeutic insights from the zebrafish host model
Torraca, V., Masud, S., Spaink, H.P. and Meijer, A.H. 2014. Macrophage-pathogen interactions in infectious diseases: new therapeutic insights from the zebrafish host model. Disease Models and Mechanisms. 7 (7), pp. 785-797. https://doi.org/10.1242/dmm.015594

Morphological and molecular characterization of a marine fish trypanosome from South Africa, including its development in a leech vector
Hayes, P.M., Lawton, S.P., Smit, N.J., Gibson, W.C. and Davies, A.J. 2014. Morphological and molecular characterization of a marine fish trypanosome from South Africa, including its development in a leech vector. Parasites and Vectors. 7 (50). https://doi.org/10.1186/1756-3305-7-50

Modulation of a cytoskeletal calpain-like protein induces major transitions in trypanosome morphology
Hayes, P.M., Varga, V., Olego-Fernandez, S., Sunter, J., Ginger, M.L., Gull, K. and Dr Michael Ginger 2014. Modulation of a cytoskeletal calpain-like protein induces major transitions in trypanosome morphology. Journal of Cell Biology. 206 (3), pp. 377-384. https://doi.org/10.1083/jcb.201312067

Telaprevir or boceprevir based therapy for chronic hepatitis C infection: Development of resistance-associated variants in treatment failure
Macartney, M.J., Irish, D., Bridge, S.H., Garcia-Diaz, A., Booth, C., McCormick, A.L., Labbett, W., Smith, C., Velazquez, C., Tanwar, S., Trembling, P., Jacobs, M., Dusheiko, G., Rosenberg, W.M. and Haque, T. 2014. Telaprevir or boceprevir based therapy for chronic hepatitis C infection: Development of resistance-associated variants in treatment failure. Antiviral Research. 105, pp. 112-7. https://doi.org/10.1016/j.antiviral.2014.02.019

Prevalence of baseline polymorphisms for potential resistance to NS5A inhibitors in drug-naive individuals infected with hepatitis C genotypes 1–4
McCormick, A.L., Wang, L., Garcia-Diaz, A., Macartney, M.J., Webster, D.P. and Haque, T. 2014. Prevalence of baseline polymorphisms for potential resistance to NS5A inhibitors in drug-naive individuals infected with hepatitis C genotypes 1–4 . Antiviral Therapy. 20 (1), pp. 81-85. https://doi.org/10.3851/IMP2763

The utility of different bioinformatics algorithms for genotypic HIV-1 tropism testing in a large clinical cohort with multiple subtypes
Bartlett, A., Macartney, M.J., Conibear, T., Feyertag, F., Smith, C., Johnson, M., Hyams, C., Garcia-Diaz, A., McCormick, A.L., Booth, C., Robertson, D. and Webster, D.P. 2014. The utility of different bioinformatics algorithms for genotypic HIV-1 tropism testing in a large clinical cohort with multiple subtypes. AIDS. 28 (11), pp. 1611-7. https://doi.org/10.1097/QAD.0000000000000288

Baseline drug-resistance mutations are detectable in HCV genes NS3 and NS5A but not NS5B in acute and chronic HIV-coinfected patients
McCormick, A.L., Moynihan, L., Macartney, M.J., Garcia-Diaz, A., Smith, C., Johnson, M., Rodger, A.J., Bhagani, S., Haque, T. and Webster, D. 2014. Baseline drug-resistance mutations are detectable in HCV genes NS3 and NS5A but not NS5B in acute and chronic HIV-coinfected patients. Antiviral Therapy. 20 (3), p. 2015. https://doi.org/10.3851/IMP2871

Robotic injection of zebrafish embryos for high-throughput screening in disease models
Spaink, Herman P., Cui, Chao, Wiweger, Malgorzata I., Jansen, Hans J., Veneman, Wouter J., Marin-Juez, Ruben, de Sonneville, Jan, Ordas, Anita, Torraca, V., van der Ent, Wietske, Leenders, William P., Meijer, Annemarie H., Snaar-Jagalska, B. Ewa and Dirks, Ron P. 2013. Robotic injection of zebrafish embryos for high-throughput screening in disease models. Methods. 62 (3), pp. 246-254. https://doi.org/10.1016/j.ymeth.2013.06.002

Evaluation of the Roche prototype 454 HIV-1 ultradeep sequencingdrug resistance assay in a routine diagnostic laboratory
Garcia-Diaz, A., Guerrero-Ramos, A., McCormick, A.L., Macartney, M.J., Conibear, T., Johnson, M., Haque, T. and Webster, D.P. 2013. Evaluation of the Roche prototype 454 HIV-1 ultradeep sequencingdrug resistance assay in a routine diagnostic laboratory. Journal of Clinical Virology. 58 (2), pp. 468-473. https://doi.org/10.1016/j.jcv.2013.07.009

Ultra-small graphene oxide functionalized with polyethylenimine (PEI) for very efficient gene delivery in cell and zebrafish embryos
Zhou, Xiang, Laroche, Fabrice, Lamers, Gerda E. M., Torraca, V., Voskamp, Patrick, Lu, Tao, Chu, Fuqiang, Spaink, Herman P., Abrahams, Jan Pieter and Liu, Zunfeng 2012. Ultra-small graphene oxide functionalized with polyethylenimine (PEI) for very efficient gene delivery in cell and zebrafish embryos. Nano Research. 5, pp. 703-709. https://doi.org/10.1007/s12274-012-0254-x

The genus Caligus Müller, 1785 (Copepoda: Siphonostomatoida): two new species from reef associated fishes in New Caledonia, and some nomenclatural problems resolved
Hayes, P.M., Justine, J.-L. and Boxshall, G. 2012. The genus Caligus Müller, 1785 (Copepoda: Siphonostomatoida): two new species from reef associated fishes in New Caledonia, and some nomenclatural problems resolved. Zootaxa. 3534, pp. 21-39.

Impact of the N348I Mutation in HIV-1 Reverse Transcriptase on Nonnucleoside Reverse Transcriptase Inhibitor Resistance in Non-Subtype B HIV-1
McCormick, A.L., Parry, C.M., Crombe, A., Goodall, R.L., Gupta, R.K., Kaleebu, P., Kityo, C., Chirara, M., Towers, G.J. and Pillay, D. 2011. Impact of the N348I Mutation in HIV-1 Reverse Transcriptase on Nonnucleoside Reverse Transcriptase Inhibitor Resistance in Non-Subtype B HIV-1. Antimicrobial Agents and Chemotherapy. 55 (4), pp. 1806-1809. https://doi.org/10.1128/AAC.01197-10

Three-dimensional visualisation of developmental stages of an apicomplexan fish blood parasite in its invertebrate host
Hayes, P.M., Wertheim, D.F., Smit, N.J., Seddon, A.M. and Davies, A.J. 2011. Three-dimensional visualisation of developmental stages of an apicomplexan fish blood parasite in its invertebrate host. Parasites and Vectors. 4 (219). https://doi.org/10.1186/1756-3305-4-219

Unexpected response of a captive blackeye thicklip, Hemigymnus melapterus (Bloch), from Lizard Island, Australia, exposed to juvenile isopods Gnathia aureamaculosa Ferreira & Smit
Hayes, P.M., Smit, N.J., Grutter, A.S. and Davies, A.J. 2011. Unexpected response of a captive blackeye thicklip, Hemigymnus melapterus (Bloch), from Lizard Island, Australia, exposed to juvenile isopods Gnathia aureamaculosa Ferreira & Smit. Journal of Fish Diseases. 34 (7), pp. 563-566. https://doi.org/10.1111/j.1365-2761.2011.01261.x

Full length HIV-1 Gag determines protease inhibitor susceptibility within in vitro assays
Gupta, R.K., Kohli, A., McCormick, A.L., Towers, G.J., Pillay, D. and Parry, C.M. 2010. Full length HIV-1 Gag determines protease inhibitor susceptibility within in vitro assays. AIDS. 24 (11), p. 1651–1655. https://doi.org/10.1097/QAD.0b013e3283398216

Lack of Minority K65RResistant Viral Populations Detected After Repeated Treatment Interruptions of Tenofovir/Zidovudine and Lamivudine in a Resource-Limited Setting
McCormick, A.L., Goodall, R.L., Joyce, A., Ndembi, N., Chirara, M., Katunduk, P., Walker, A.S., Yirrell, D.L., Gilks, C.F. and Pillay, D. 2010. Lack of Minority K65RResistant Viral Populations Detected After Repeated Treatment Interruptions of Tenofovir/Zidovudine and Lamivudine in a Resource-Limited Setting. Journal of Acquired Immune Deficiency Syndromes. 54 (2), pp. 215-216. https://doi.org/10.1097/QAI.0b013e3181cc1058

Viral Rebound and Emergence of Drug Resistance in the Absence of Viral Load Testing: A Randomized Comparison between Zidovudine-Lamivudine plus Nevirapine and Zidovudine-Lamivudine plus Abacavir
Ndembi, N., Goodall, R.L., Dunn, D.T., McCormick, A.L., Burke, A., Lyagoba, F., Munderi, P., Katundu, P., Kityo, C., Robertson, V., Yirrell, D.L., Walker, A.S., Gibb, D.M., Gilks, C.F., Kaleebu, P. and Pillay, D. 2010. Viral Rebound and Emergence of Drug Resistance in the Absence of Viral Load Testing: A Randomized Comparison between Zidovudine-Lamivudine plus Nevirapine and Zidovudine-Lamivudine plus Abacavir. The Journal of Infectious Diseases. 201 (1), pp. 106-113. https://doi.org/10.1086/648590

Quantification of reverse transcriptase in ALS and elimination of a novel retroviral candidate
McCormick, A.L., Brown, R.H., Cudkowicz, M.E., Al-Chalabi, A. and Garson, J.A. 2008. Quantification of reverse transcriptase in ALS and elimination of a novel retroviral candidate. Neurology. 70 (4), pp. 278-283. https://doi.org/10.1212/01.wnl.0000297552.13219.b4

Pathology associated with parasitic juvenile gnathiids feeding on the puffadder shyshark, Haploblepharus edwardsii (Voight)
Hayes, P.M., Smit, N.J. and Davies, A.J. 2007. Pathology associated with parasitic juvenile gnathiids feeding on the puffadder shyshark, Haploblepharus edwardsii (Voight). Journal of Fish Diseases. 30 (1), pp. 55-58. https://doi.org/10.1111/j.1365-2761.2007.00777.x

A new fish haemogregarine from South Africa and its suspected dual transmission with trypanosomes by a marine leech
Hayes, P.M., Smit, N.J., Seddon, A.M., Wertheim, D.F. and Davies, A.J. 2006. A new fish haemogregarine from South Africa and its suspected dual transmission with trypanosomes by a marine leech. Folia Parasitologica. 53 (4), pp. 241-248. https://doi.org/10.14411/fp.2006.031

An interferon gamma-gp120 fusion delivered as a DNA vaccine induces enhanced priming
Nimal, S., McCormick, A.L., Thomas, M.S. and Heath, A.W. 2005. An interferon gamma-gp120 fusion delivered as a DNA vaccine induces enhanced priming. Vaccine. 23 (10), pp. 3984-3990. https://doi.org/10.1016/j.vaccine.2005.01.160

CD40 antibody as an adjuvant induces enhanced T cell responses
Carlring, J., Barr, T.A., McCormick, A.L. and Heath, A.W. 2004. CD40 antibody as an adjuvant induces enhanced T cell responses. Vaccine. 22 (25-26), p. 3323–3328. https://doi.org/10.1016/j.vaccine.2004.02.043

Haemogregarina bigemina (Protozoa : Apicomplexa : Adeleorina) – Past, present and future
Davies, A.J., Smit, N.J., Hayes, P.M., Seddon, A.M. and Wertheim, D.F. 2004. Haemogregarina bigemina (Protozoa : Apicomplexa : Adeleorina) – Past, present and future . Folia Parasitologica. 51 (2/3), pp. 99-108. https://doi.org/10.14411/fp.2004.015

A potent adjuvant effect of CD40 antibody attached to antigen
Barr, T.A., McCormick, A.L., Carlring, J. and Heath, A.W. 2003. A potent adjuvant effect of CD40 antibody attached to antigen. Immunology. 109 (1), pp. 87-92. https://doi.org/10.1046/j.1365-2567.2003.01634.x

Immunization with an Interferon-g–gp120 Fusion Protein Induces Enhanced Immune Responses to Human Immunodeficiency Virus gp120
McCormick, A.L., Thomas, M.S. and Heath, A.W. 2001. Immunization with an Interferon-g–gp120 Fusion Protein Induces Enhanced Immune Responses to Human Immunodeficiency Virus gp120. The Journal of Infectious Diseases. 184 (11), pp. 1423-1430. https://doi.org/10.1086/324371

Gag Determinants of Fitness and Drug Susceptibility in Protease Inhibitor-Resistant Human Immunodeficiency Virus Type 1
Parry, C.M., Kohli, A., Boinett, C.J., Towers, G.J., McCormick, A.L. and Pillay, D. 1999. Gag Determinants of Fitness and Drug Susceptibility in Protease Inhibitor-Resistant Human Immunodeficiency Virus Type 1. Journal of Virology. 83 (18), pp. 9094-9101. https://doi.org/10.1128/JVI.02356-08

Cell Surface Expression of CD154 Inhibits Alloantibody Responses: A Mechanism for the Prevention of Autoimmune Responses against Activated T Cells?
McCormick, A.L., Santos-Argumedo, L., Thomas, M.S. and Heath, A.W. 1999. Cell Surface Expression of CD154 Inhibits Alloantibody Responses: A Mechanism for the Prevention of Autoimmune Responses against Activated T Cells? Cellular Immunology. 195 (2), pp. 157-161. https://doi.org/10.1006/cimm.1999.1528

Enhancement of immunogenicity of recombinant antigens by production of a cytokine-antigen fusion protein for vaccination
McCormick, A.L., Thomas, M.S. and Heath, A.W. 1997. Enhancement of immunogenicity of recombinant antigens by production of a cytokine-antigen fusion protein for vaccination. Biochemical Society Transactions. 25, p. 297S. https://doi.org/10.1042/bst025297s

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