Escherichia coli producing the highly virulent, multidrug-resistant, CTX-M-15 extended-spectrum -lactamase (ESBL), sequence type 131 (ST131), has emerged on three continents since the late 2000s. We described the molecular epidemiology, clinical features, and outcome of ESBL-producing E. coli bacteremia in Taiwan Independent risk factors predicting mortality at day 28 included malignancy, shock, and hospital-acquired bacteremia. In ESBLproducing E. coli bloodstream infections, the ST131 clone was not associated with health-care-associated risk factors, such as urinary catheter use or antibiotic exposure. Although highly virulent and multidrug resistant, the ST131 clone was not associated with higher mortality than non-ST131 clones.
Between 2000 and 2006, Escherichia coli clone O25:H4-ST131, which produces CTX-M-15 extended-spectrum -lactamase (ESBL), was identified on three continents and later found to be widespread in Europe, Australia, and the United States of America (6,11,13,17,19,22,24). The sequence type 131 (ST131) strain was associated with high, homogenous, extraintestinal virulence and multidrug resistance (6,11,13,17,19,22,24). Virulence gene analysis indicated that clone ST131 strains were more likely than non-ST131 strains to possess traT, iutA, iha, ompT, fimH, malX, fyuA, kpsM, or sat genes (6, 11, 13, 17, 19, 22, 24). Pulsotype analysis revealed that CTX-M-15 ST131 clones were usually approximately 85% similar (6,11,13,17,19,22,24).According to the published literature, most ST131 clones have been identified as a result of urine culture surveillance, and a few have been isolated from individuals with bacteremia. ST131 clones have been observed in the community, hospitals, and nursing homes (6,11,13,17,19,22,24) as well as in companion animals and poultry (23). In a French study, ST131 isolates were found in 7% of fecal E. coli isolates from independent healthy subjects and were unaccompanied by the CTX-M enzyme (14). However, several case reports have shown that ST131 clones can present in cases of severe infection, such as pyomyositis, emphysematous pyelonephritis, and other life-threatening infections (10,18,28). Only two cohorts with ST131 ESBL E. coli bacteremia have been reported in the literature. In these two ESBL E. coli bacteremia series, ST131 was found in 34% of isolates in the Netherlands (27) and 31.3% of isolates in Calgary, Canada (21). In Calgary's ESBL E. coli bacteremia cohort (21), ST131 isolates producing CTX-M-15 became predominant from 2005 to 2007 and were associated with community-onset infection and urosepsis. However, the detailed demographic features, clinical syndromes, and outcomes in these two cohorts of patients with ESBL E. coli bacteremia in clone ST131 are lacking. In previous risk factor analyses, ESBL E. coli infection was more closely associated with antibiotic use, comorbidity, and urinary catheter use than non-ESBL E. coli infection (2, 9, 15). We did not know whether ST131 clones were associated with the same risk factors as previous traditional ESBL E...