Clinical and Molecular Correlates of Escherichia coli Bloodstream Infection from Two Geographically Diverse Centers in Rochester, Minnesota, and Singapore

Abstract

bacteremia is caused mainly by sequence type complex 131 (STc131) and two clades within its fluoroquinolone-resistance-associated 30 subclone,30R1 and 30Rx. We examined clinical and molecular correlates of bacteremia in two geographically distinct centers. We retrospectively studied 251 unique bloodstream isolates from 246 patients (48 from the Mayo Clinic, Rochester, MN [MN], and 198 from Tan Tock Seng Hospital, Singapore [SG]), from October 2013 through March 2014. Isolates underwent PCR for phylogroup, STc, type, and virulence gene profiles, and medical records were reviewed. Although STc131 accounted for 25 to 27% of all bacteremia isolates at each site, its extended-spectrum-β-lactamase (ESBL)-associated30Rx clade was more prominent in SG than in MN (15% versus 4%; = 0.04). In SG only, patients with STc131 (versus other STc isolates) were more likely to receive inactive initial antibiotics (odds ratio, 2.8; = 0.005); this was true specifically for patients with30Rx (odds ratio, 7.0; = 0.005).30Rx comprised 16% of community-onset bacteremia episodes in SG but none in MN. In SG, virulence scores were higher for 30Rx than for30R1, non-30 STc131, and non-STc131 isolates ( < 0.02 for all comparisons). At neither site did mortality differ by clonal status. The ESBL-associated 30Rx clade was more prevalent and more often of community onset in SG, where it predicted inactive empirical treatment. The clonal distribution varies geographically and has potentially important clinical implications. Rapid susceptibility testing and clonal diagnostics for30/30Rx might facilitate earlier prescribing of active therapy.

Sequence Types, Clonotypes, Serotypes, and Virotypes of Extended-Spectrum β-Lactamase-Producing Escherichia coli Causing Bacteraemia in a Spanish Hospital Over a 12-Year Period (2000 to 2011)

“…ESBL production in E. coli has increased due mainly to the spread of CTX-M enzymes. The high-risk clones have played a very important role in the current pandemic spread, especially the ST131 clone associated with the CTX-M-15 enzyme (Nicolas-Chanoine et al, 2008; Chung et al, 2012; Peirano et al, 2012; Adams-Sapper et al, 2013; Banerjee et al, 2013; Colpan et al, 2013; Matsumura et al, 2013; Johnson et al, 2017; Kallonen et al, 2017; Roer et al, 2017; Mendis et al, 2018).…”

Novel Multiplex PCR Method and Genome Sequence-Based Analog for High-Resolution Subclonal Assignment and Characterization of Escherichia coli Sequence Type 131 Isolates

“… Escherichia coli sequence type 131 (ST131), which arguably is the most epidemiologically successful multidrug-resistant E. coli lineage ever identified, emerged dramatically beginning in approximately 2000 to become a pandemic pathogen ( 1 – 5 ). ST131 now accounts for the greatest share of multidrug-resistant human extraintestinal E. coli infections worldwide ( 6 – 12 ).…”

Expansion of a subset within C2 clade of Escherichia coli sequence type 131 (ST131) is driving the increasing rates of Aminoglycoside resistance: a molecular epidemiology report from Iran

“…Sequence type 131 (ST131), the currently emerged clone of Escherichia coli which is disseminated worldwide cause severe hospital-acquired and community-onset infections ( 1, 2 ). The pervasiveness of ST131 has been reported by many global surveys and increasing prevalence of fluoroquinolone and cephalosporine resistance in E. coli population is attributed to this clone ( 3 ).…”