Identification of CTX-M β-lactamases in Escherichia coli from hospitalized patients and residents of long-term care facilities

Urban, Carl; Mariano, Noriel; Bradford, Patricia A.; Tuckman, Margareta; Segal‐Maurer, Sorana; Wehbeh, Wehbeh; Grenner, Louise; Colon-Urban, Rita; Johnston, Brian; Johnson, James R.; Rahal, James J.

doi:10.1016/j.diagmicrobio.2009.11.012

Cited by 34 publications

(31 citation statements)

References 23 publications

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“…Recent hospitalization and preadmission care in an LTCF are well-documented predictors of colonization and/or infection by antibioticresistant strains of bacteria (regardless of species) (2,47). LTCFs have frequently been singled out as important reservoirs of antibiotic-resistant Enterobacteriaceae (30,48), and this is particularly true for P. mirabilis in Italy (25,29,31,34). Movement of patients and staff between long-term care and acute-care facilities would be expected to promote the spread of resistant bacteria.…”

Section: Discussionmentioning

confidence: 99%

Multidrug-Resistant Proteus mirabilis Bloodstream Infections: Risk Factors and Outcomes

Tumbarello

Trecarichi

Fiori

et al. 2012

Antimicrob Agents Chemother

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Our aims were to identify (i) risk factors associated with the acquisition of multidrug-resistant (MDR, to 3 or more classes of antimicrobials) Proteus mirabilis isolates responsible for bloodstream infections (BSIs) and (ii) the impact on mortality of such infections. Risk factors for acquiring MDR P. mirabilis BSIs were investigated in a case-case-control study; those associated with mortality were assessed by comparing survivors and nonsurvivors in a cohort study. The population consisted of 99 adult inpatients with P. mirabilis BSIs identified by our laboratory over an 11-year period (1999 to 2009), 36 (33.3%) of which were caused by MDR strains, and the overall 21-day mortality rate was 30.3%. Acquisition of an MDR strain was independently associated with admission from a long-term care facility (odds ratio to which the isolate displayed in vitro resistance) more frequently than those with non-MDR infections; they also had increased mortality and (for survivors) longer post-BSI-onset hospital stays. In multivariate regression analysis, 21-day mortality was associated with septic shock at BSI onset (OR, 12.97; 95% CI, 32.2 to 52.23), P. mirabilis isolates that were MDR (OR, 6.62; 95% CI, 16.4 to 26.68), and IIAT (OR, 9.85; 95% CI, 26.7 to 36.25), the only modifiable risk factor of the 3. These findings can potentially improve clinicians' ability to identify P. mirabilis BSIs likely to be MDR, thereby reducing the risk of IIAT-a major risk factor for mortality in these cases-and facilitating the prompt implementation of appropriate infection control measures. The Gram-negative enteric bacterium Proteus mirabilis is an important cause of community-and health care-associated infections, including those involving the urinary tract, the abdominal cavity, and the bloodstream itself (13,19,50). Like many other members of the family Enterobacteriaceae, P. mirabilis can harbor numerous plasmid-and integron-mediated determinants of antimicrobial resistance (18). Multidrug-resistant (MDR) strains of P. mirabilis generally produce extended-spectrum ␤-lactamases (ESBLs) or the AmpC-type cephalosporinase and rarely carbapenemases, and their prevalence in some settings is relatively high (8,10,12,13,25,31,39,41).Over the past decade, the proportion of BSIs caused by Gramnegative bacteria has risen sharply (11,26,38,51). Although 1 to 3% of all BSIs are caused by P. mirabilis (11,26,38,51), the incidence of MDR in the strains responsible for these infections is a cause for concern. In general, MDR infections are known to have a significant impact on the prognosis and survival of hospitalized patients (9,14,24,42,43,46), but it is unclear whether MDR strains are associated with worse clinical outcomes in P. mirabilis BSIs. Endimiani et al. (13) found that treatment failure and death are likely to occur in ESBL-producing P. mirabilis BSIs. Unfortunately, this study was small, including 23 patients and only 9 patients with ESBL BSIs. However, we can reasonably assume that empirical therapy is even more likely to be inadequate...

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Section: Discussionmentioning

confidence: 99%

Multidrug-Resistant Proteus mirabilis Bloodstream Infections: Risk Factors and Outcomes

Tumbarello

Trecarichi

Fiori

et al. 2012

Antimicrob Agents Chemother

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“…The 351 ESBL-positive E. coli study isolates, including some previously published isolates (16,17,27,29), were obtained as a series of convenience samples from colleagues at 15 research or clinical laboratories across the United States (Table 1). Each center was invited to submit all available E. coli clinical isolates that met the study criteria, including (i) isolation from 2000 to 2009 and (ii) confirmed ESBL production according to Clinical and Laboratory Standards Institute (CLSI) criteria (4).…”

Section: Methodsmentioning

confidence: 99%

“…Subsequently, case reports and small series documented the presence of ST131 also in the United States, with the ESBL-positive ST131 isolates usually producing CTX-M-15 (6,7,9,11,17,20,27,29,30). The only published large-scale survey to date for ST131 in the United States appeared in 2010 and was based on clinical isolates from 2007 from two national surveillance programs (8).…”

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confidence: 99%

Molecular Epidemiological Analysis of Escherichia coli Sequence Type ST131 (O25:H4) and bla _CTX-M-15 among Extended-Spectrum-β-Lactamase-Producing E. coli from the United States, 2000 to 2009

Johnson

Urban

Weissman

et al. 2012

Antimicrob Agents Chemother

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ABSTRACTEscherichia colisequence type ST131 (from phylogenetic group B2), often carrying the extended-spectrum-β-lactamase (ESBL) geneblaCTX-M-15, is an emerging globally disseminated pathogen that has received comparatively little attention in the United States. Accordingly, a convenience sample of 351 ESBL-producingE. coliisolates from 15 U.S. centers (collected in 2000 to 2009) underwent PCR-based phylotyping and detection of ST131 andblaCTX-M-15. A total of 200 isolates, comprising 4 groups of 50 isolates each that were (i)blaCTX-M-15negative non-ST131, (ii)blaCTX-M-15positive non-ST131, (iii)blaCTX-M-15negative ST131, or (iv)blaCTX-M-15positive ST131, also underwent virulence genotyping, antimicrobial susceptibility testing, and pulsed-field gel electrophoresis (PFGE). Overall, 201 (57%) isolates exhibitedblaCTX-M-15, whereas 165 (47%) were ST131. ST131 accounted for 56% ofblaCTX-M-15-positive- versus 35% ofblaCTX-M-15-negative isolates (P< 0.001). Whereas ST131 accounted for 94% of the 175 total group B2 isolates, non-ST131 isolates were phylogenetically distributed byblaCTX-M-15status, with groups A (blaCTX-M-15-positive isolates) and D (blaCTX-M-15-negative isolates) predominating. BothblaCTX-M-15and ST131 occurred at all participating centers, were recovered from children and adults, increased significantly in prevalence post-2003, and were associated with molecularly inferred virulence. Compared with non-ST131 isolates, ST131 isolates had higher virulence scores, distinctive virulence profiles, and more-homogeneous PFGE profiles.blaCTX-M-15was associated with extensive antimicrobial resistance and ST131 with fluoroquinolone resistance. Thus,E. coliST131 andblaCTX-M-15are emergent, widely distributed, and predominant among ESBL-positiveE. colistrains in the United States, among children and adults alike. Enhanced virulence and antimicrobial resistance have likely promoted the epidemiological success of these emerging public health threats.

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“…Accordingly, to ensure appropriate empirical therapy, ED physicians may need to consider the possibility of community-acquired ESBLs, even in pediatric patients who lack identifiable risk factors, especially in high-prevalence locales for ESBL-producing E. coli (11,12).…”

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confidence: 99%

Community-Associated Escherichia coli Harboring CTX-M β-Lactamases from Urine Cultures from Pediatric Patients

Woods¹,

Johnson²,

Padkowsky³

et al. 2012

Antimicrob Agents Chemother

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Identification of CTX-M β-lactamases in Escherichia coli from hospitalized patients and residents of long-term care facilities

Cited by 34 publications

References 23 publications

Multidrug-Resistant Proteus mirabilis Bloodstream Infections: Risk Factors and Outcomes

Multidrug-Resistant Proteus mirabilis Bloodstream Infections: Risk Factors and Outcomes

Molecular Epidemiological Analysis of Escherichia coli Sequence Type ST131 (O25:H4) and bla _CTX-M-15 among Extended-Spectrum-β-Lactamase-Producing E. coli from the United States, 2000 to 2009

Community-Associated Escherichia coli Harboring CTX-M β-Lactamases from Urine Cultures from Pediatric Patients

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Identification of CTX-M β-lactamases in Escherichia coli from hospitalized patients and residents of long-term care facilities

Cited by 34 publications

References 23 publications

Multidrug-Resistant Proteus mirabilis Bloodstream Infections: Risk Factors and Outcomes

Multidrug-Resistant Proteus mirabilis Bloodstream Infections: Risk Factors and Outcomes

Molecular Epidemiological Analysis of Escherichia coli Sequence Type ST131 (O25:H4) and bla CTX-M-15 among Extended-Spectrum-β-Lactamase-Producing E. coli from the United States, 2000 to 2009

Community-Associated Escherichia coli Harboring CTX-M β-Lactamases from Urine Cultures from Pediatric Patients

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Molecular Epidemiological Analysis of Escherichia coli Sequence Type ST131 (O25:H4) and bla _CTX-M-15 among Extended-Spectrum-β-Lactamase-Producing E. coli from the United States, 2000 to 2009