European Emergence of Ciprofloxacin-Resistant Escherichia coli Clonal Groups O25:H4-ST 131 and O15:K52:H1 Causing Community-Acquired Uncomplicated Cystitis

Abstract

A total of 148 E. coli strains displaying reduced susceptibility to ciprofloxacin (MIC > 2 g/ml) and causing uncomplicated urinary tract infections in eight European countries during 2003 to 2006 were studied. Their phylogenetic groups, biochemical profiles, and antibiotic susceptibilities were determined. Determination of the O:H serotype, pulsed-field gel electrophoresis (PFGE), randomly amplified polymorphic DNA (RAPD) PCR, and multilocus sequence typing provided additional discrimination. The majority (82.4%) of the microorganisms (122/148) carried resistance to two or more additional drugs, with the pattern ciprofloxacin-trimethoprim-sufamethoxazole-tetracycline-ampicillin being the most represented (73 strains out of 148; 49.3%). Extended-spectrum beta-lactamase production was detected in 12/148 strains (8.1%), with CTX-M-15 being the most-common enzyme. Six strains out of the whole collection studied (4.0%) contained a qnrB-like gene. Overall, 55 different PFGE or RAPD PCR profiles could be distinguished, indicating a substantial heterogeneity. However, about one-third (51/148) of the strains belonged to two clonal groups: O15:K52:H1 (phylogenetic group B2, lactose-nonfermenting variant, ciprofloxacin MIC of 16 g/ml) and O25:H4 sequence type 131 (ST-131) (phylogenetic group D, ciprofloxacin MIC of >32 g/ml). With the exception of Poland, strains of these two groups were isolated in samples from all participating countries but more frequently in samples from Spain and Italy. In some representative strains of the two main clonal groups, alterations in GyrA and ParC were the basic mechanism of fluoroquinolone resistance. In some members of the O25:H4 ST-131 group, displaying a ciprofloxacin MIC of >32 g/ml, additional OmpF loss or pump efflux overexpression was found. In the Mediterranean area, strains belonging to these two clonal groups played a major role in determining the high rate of fluoroquinolone-resistant E. coli strains observed in the community.Uncomplicated urinary tract infections (UTIs) are among the most prevalent infectious diseases mainly affecting women. Between one-quarter and one-half of all women experience a UTI at some time (27).The overall etiology has not changed in recent years, and Escherichia coli remains by far the most-common uropathogen, accounting for Ͼ80% of all positive cultures (19). However, the management of these infections is becoming complicated due to the emergence of resistance to several first-line antimicrobial agents in this primary pathogen (13).In fact, in E. coli bacteria, ampicillin and sulfamethoxazoletrimethoprim resistance rates have reached 20% to 50% worldwide. In Europe, increasing percentages of ciprofloxacinresistant mutants have been observed in the community in Spain, Portugal, and Italy (10,18).The results of a recent surveillance survey, the ARESC (Antimicrobial Resistance Epidemiological Survey on Cystitis) study, have shown high rates (Ͼ10%) of ciprofloxacin-resistant E. coli in Spain, Italy, and Russia and the emergence of this problem in all c...

Incidence of Antibiotic-Resistant Escherichia coli Bacteriuria According to Age and Location of Onset: A Population-Based Study From Olmsted County, Minnesota

“…The incidence of drug-resistant E coli also increased significantly among CA isolates, suggesting that younger adults (ages 18-64 years), who contributed half of the CA isolates in this study, are also at risk for drug-resistant E coli. This increase in resistance among E coli in the community has been reported in numerous studies 3,4,[39][40][41] and may be due to several factors, including increasing reliance on outpatient medical management, increasing antimicrobial use in the outpatient setting, transmission of drug-resistant strains from the hospital into the community, or expansion of drug-resistant clones within the community. 3,14,18,42 Because resistance to fluoroquinolone and fluoroquinolone plus trimethoprim-sulfamethoxazole increased more markedly than resistance to other antibiotics among our E coli isolates from 2005 through 2009, we hypothesize that there has been expansion of drug-resistant clones within Olmsted County.…”

“…2,6 In addition, extended-spectrum ␤-lactamase and carbapenemase-producing E coli strains, such as were historically associated with nosocomial or health care-associated (HA) infections, are now prevalent in the community. 2,6,[12][13][14] Most studies that have examined antibiotic resistance among E coli isolates have included convenience samples, 1,2,4,5,[15][16][17][18][19] and only 2 have been population based. 20,21 Thus, it is unclear whether the increase in antibiotic-resistant E coli infections is disproportionately affecting specific patient groups.…”

UPEC strain characterization isolated from Mexican patients with recurrent urinary infections

“…This strain is found globally and produces extended spectrum β-lactamase. It has also shown fluoroquinolone antimicrobial resistance, as well as co-resistance to aminoglycosides and trimethoprim-sulfamethoxazole [34]. There are some reports of E. coli ST131 strains resistant to carbapenems [35].…”

“…Further studies will be necessary to confirm or discard that the E. coli O25:H4 ST 131 strains of this study correspond to same clone circulating in different countries in the world [13], but what is striking is that E. coli O25:4 ST131 has been isolated almost exclusively from samples of cystitis [34] from women. It is important to study a large number of cystitis strains from women as also from men in Mexico to determine if this E. coli type with the genetic characteristic found in this study, occurs only in cystitis isolates in both genders or exclusively in females, or is associated to recurrent urinary infection.…”

Current Management Strategies for Uncomplicated and Complicated Cystitis

“…Their resistance is less than 5% in most regions (Hooton et al 2004, Warren et al 1999); however resistance rates are beginning to increase worldwide (although not as high as that of TMP-SMX) (Yamamoto et al 2010) (Muratani and Matsumoto 2006). In the Mediterranean region up to one-third of strains that demonstrate reduced susceptibility to flouroquinolones and cause uncomplicated cystitis belong to two clonal groups: O15:H1 and O25:H4 (Cagnacci et al 2008). This implies that strains belonging to these two clonal groups play a major role in determining the increasing rate of flouroquinolone resistant E. coli strains in the community.…”