Rapid and Extensive Expansion in the United States of a New Multidrug-resistantEscherichia coliClonal Group, Sequence Type 1193

Abstract

We describe the rapid and ongoing emergence across multiple US cities of a new multidrug-resistant Escherichia coli clonesequence type (ST) 1193-resistant to fluoroquinolones (100%), trimethoprim-sulfamethoxazole (55%), and tetracycline (53%). ST1193 is associated with younger adults (age <40 years) and currently comprises a quarter of fluoroquinolone-resistant clinical E. coli urine isolates.

Rapid Emergence, Subsidence, and Molecular Detection of Escherichia coli Sequence Type 1193- fimH64 , a New Disseminated Multidrug-Resistant Commensal and Extraintestinal Pathogen

“…Fifth, our novel ST1193-H64 PCR-based assay was simple and accurate and so should facilitate the molecular epidemiological studies needed to further assess the prevalence, ecology, and clinical significance of ST1193-H64. Regarding clonal emergence, several recent reports have documented ST1193-H64 as an emerging contributor to the FQ-R E. coli population (7)(8)(9)(10)(11)(12)(13), usually second only to ST131-H30, which in contrast emerged globally beginning nearly 2 decades ago (6,24,(36)(37)(38)(39)(40). Our findings suggest a staggered timing for the emergence of ST1193-H64 at different centers, with historical isolates from Australia dating to 2008; a low prevalence in 2011 in Olmsted County, MN, and at VAMCs nationally in the United States; and a later appearance at MVAMC (2013), followed by a rapid rise and then a plateau and even a possible decline (fecal colonization).…”

“…The emerging resistance is due mainly to a few widely disseminated clones, most notably the H30R subclone of sequence type 131 (ST131-H30R; associated with allele 30 of fimH [type 1 fimbrial adhesin]), which derives from virulence-associated phylogroup B2 (3)(4)(5)(6). Recent reports from diverse locales describe a possible new such clone, ST1193, which likewise is from phylogroup B2 but, unlike ST131, represents sequence type complex 14 (STc14) and is associated with fimH allele 64, i.e., ST1193-H64 (7)(8)(9)(10)(11)(12).…”

“…Subsequent reports from China (9,10), Korea (11), Norway (12), Germany (13), and the United States (8) documented ST1193 as a progressively emerging FQ-R human pathogen in these regions, often second only to ST131-H30R among FQ-R isolates and sometimes associated with CTX-M extended-spectrum beta-lactamases (ESBLs) (9,12). These isolates' virulence genotype, O type, and lactose-negative phenotype, when reported, have resembled those of the 2008 Australian isolates, suggesting global clonal dissemination.…”

Antimicrobial resistant and extended‐spectrum β‐lactamase producing Escherichia coli in common wild bird species in Switzerland

“…The majority of these, including ST58, ST205, ST540, and ST1722, have already been reported in ESBL‐producing E. coli from waterfowl in Pakistan (Mohsin et al., ), gulls in Chile (Hernandez et al., ) Portugal (Guenther et al., ) and Sweden (Atterby et al., ). Interestingly, E. coli ST1193 belongs to extraintestinal pathogenic pandemic clonal group associated with urinary tract infections (UTIs) in humans and is, similar to the E. coli ST131 H30 clone, an important contributor to fluoroquinolone resistance worldwide (Tchesnokova et al., ). This clone has very recently emerged as an MDR bla CTX‐M‐14 and bla CTX‐M‐15 harboring nosocomial pathogen in Germany (Valenza et al., ).…”

Ciprofloxacin facilitates the transfer of XDR plasmids from commensalE. coliinto epidemic fluoroquinolone-resistantShigella sonnei

“…Since the turn of the century, multiple cipR clones in various pathogenic species/serotypes have emerged and spread successfully in various countries, with many eventually disseminating internationally. Organisms with internationally successful cipR clones include Salmonella Typhi 56 and Shigella dysenteriae type 1 57 in South Asia, and methicillin-resistant Staphylococcus aureus ST22 58 , ST131-H30 clone of E. coli 58 , Salmonella Kentucky ST198 60 , Clostridium difficile 027 61 , Shigella sonnei 22 and E. coli ST1193 62–65 . Tracking the global transmission and local establishment of these clinically important clones through routine surveillance, particularly with the integration of genomics, has become essential for guiding public health control strategy and clinical practice.…”