Molecular epidemiology of extraintestinal pathogenic Escherichia coli isolates from a regional cohort of elderly patients highlights the prevalence of ST131 strains with increased antimicrobial resistance in both community and hospital care settings

Croxall, Gemma; Hale, James; Weston, Vivienne; Manning, Georgina; Cheetham, P.; Achtman, Mark; McNally, Alan

doi:10.1093/jac/dkr349

Cited by 91 publications

(85 citation statements)

References 22 publications

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“…CC131 (22% of the isolates), ST73 (11% of the isolates), and ST69 (9% of the isolates) were identified as the most highly represented clones in this collection. Interestingly, only 3% of the urine isolates belonged to ST95 (43). A very similar picture regarding the most prevalent phylogenetic lineages can be painted for the strain collection used in this study.…”

Section: Discussionsupporting

confidence: 60%

Characterization of Escherichia coli Isolates from Hospital Inpatients or Outpatients with Urinary Tract Infection

et al. 2014

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e Uropathogenic Escherichia coli (UPEC) is the most common cause of community-and hospital-acquired urinary tract infections (UTIs). Isolates from uncomplicated community-acquired UTIs express a variety of virulence traits that promote the efficient colonization of the urinary tract. In contrast, nosocomial UTIs can be caused by E. coli strains that differ in their virulence traits from the community-acquired UTI isolates. UPEC virulence markers are used to distinguish these facultative extraintestinal pathogens, which belong to the intestinal flora of many healthy individuals, from intestinal pathogenic E. coli (IPEC). IPEC is a diarrheagenic pathogen with a characteristic virulence gene set that is absent in UPEC. Here, we characterized 265 isolates from patients with UTIs during inpatient or outpatient treatment at a hospital regarding their phylogenies and IPEC or UPEC virulence traits. Interestingly, 28 of these isolates (10.6%) carried typical IPEC virulence genes that are characteristic of enteroaggregative E. coli (EAEC), Shiga toxin-producing E. coli (STEC), and atypical enteropathogenic E. coli (aEPEC), although IPEC is not considered a uropathogen. Twenty-three isolates harbored the astA gene coding for the EAEC heat-stable enterotoxin 1 (EAST1), and most of them carried virulence genes that are characteristic of UPEC and/or EAEC. Our results indicate that UPEC isolates from hospital patients differ from archetypal community-acquired isolates from uncomplicated UTIs by their spectrum of virulence traits. They represent a diverse group, including EAEC, as well as other IPEC pathotypes, which in addition contain typical UPEC virulence genes. The combination of typical extraintestinal pathogenic E. coli (ExPEC) and IPEC virulence determinants in some isolates demonstrates the marked genome plasticity of E. coli and calls for a reevaluation of the strict pathotype classification of EAEC.

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Section: Discussionsupporting

confidence: 60%

Characterization of Escherichia coli Isolates from Hospital Inpatients or Outpatients with Urinary Tract Infection

et al. 2014

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“…ST131 was initially considered to be particularly prevalent in community settings (1), but subsequent findings suggested otherwise (31). Here, ST131 was significantly associated with community acquisition, which accounted for 40/44 (91%) of ST131 isolates versus 53/71 (75%) of non-ST131 isolates (P Ͻ 0.001).…”

Section: Discussionmentioning

confidence: 77%

Prevalence and Characteristics of the Epidemic Multiresistant Escherichia coli ST131 Clonal Group among Extended-Spectrum Beta-Lactamase-Producing E. coli Isolates in Copenhagen, Denmark

Olesen¹,

Hansen²,

Nilsson³

et al. 2013

J Clin Microbiol

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We report the characteristics of 115 extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli clinical isolates, from 115 unique Danish patients, over a 1-year study interval (1 October 2008 to 30 September 2009). Forty-four (38%) of the ESBL isolates represented sequence type 131 (ST13)1, from phylogenetic group B2. The remaining 71 isolates were from phylogenetic groups D (27%), A (22%), B1 (10%), and B2 (3%). Serogroup O25 ST131 isolates (n ‫؍‬ 42; 95% of ST131) comprised 7 different K antigens, whereas two ST131 isolates were O16:K100:H5. Compared to non-ST131 isolates, ST131 isolates were associated positively with CTX-M-15 and negatively with CTX-M-1 and CTX-M-14. They also were associated positively with 11 virulence genes, including afa and dra (Dr family adhesins), the F10 papA allele (P fimbria variant), fimH (type 1 fimbriae), fyuA (yersiniabactin receptor), iha (adhesin siderophore), iutA (aerobactin receptor), kpsM II (group 2 capsules), malX (pathogenicity island marker), ompT (outer membrane protease), sat (secreted autotransporter toxin), and usp (uropathogenicity-specific protein) and negatively with hra (heat-resistant agglutinin) and iroN (salmochelin receptor). The consensus virulence gene profile (>90% prevalence) of the ST131 isolates included fimH, fyuA, malX, and usp (100% each), ompT and the F10 papA allele (95% each), and kpsM II and iutA (93% each). ST131 isolates were also positively associated with community acquisition, extraintestinal pathogenic E. coli (ExPEC) status, and the O25, K100, and H4 antigens. Thus, among ESBL E. coli isolates in Copenhagen, ST131 was the most prevalent clonal group, was community associated, and exhibited distinctive and comparatively extensive virulence profiles, plus a greater variety of capsular antigens than reported previously. E scherichia coli is the most common agent of urinary tract infection (UTI) and Gram-negative bacteremia. E. coli sequence type 131 (ST131) is a recently emerged worldwide pandemic clonal group, causing widespread antimicrobial-resistant infections (1). Although many studies have examined various aspects of E. coli ST131 in diverse locales and clinical contexts (1, 2), little is known about ST131's O:K:H serotypes, especially in relation to community versus health care site of acquisition, coresistance phenotypes, extended-spectrum beta-lactamase (ESBL) variants, and pulse-field gel electrophoresis (PFGE) types. Such data are needed to more fully understand the epidemiology of ST131 and to help guide diagnostic and preventive efforts.CTX-M-type beta-lactamases have become the dominant ESBLs worldwide during the past decade (3). The responsible bla CTX-M genes are known to be associated with conjugative plasmids and certain successful bacterial clones, notably ST131 (4).Here we assessed the prevalence of E. coli ST131 among 115 consecutive ESBL-producing E. coli isolates from 115 patients (2008)(2009) from 3 hospitals and 100 general practitioners' offices in Copenhagen, Denmark. Subsequently, we compared ST131 and ...

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“…Le Gall et al identified nine subgroups within group B2. Clermont et al placed E. coli ST131 in subgroup I, which was suggested to be the basal subgroup of B2 strains (15), suggesting that the characteristics of non-ST131 B2 strains may have evolved after the divergence of ST131 and related genotypes (ST1680, ST1982, and ST1461), (16,17). E. coli ST131 strains are mostly of serotype O25:H4, with a specific O25 type, O25b.…”

Section: Bacterial Characteristicsmentioning

confidence: 99%

Escherichia coli ST131, an Intriguing Clonal Group

2014

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SUMMARY In 2008, a previously unknown Escherichia coli clonal group, sequence type 131 (ST131), was identified on three continents. Today, ST131 is the predominant E. coli lineage among extraintestinal pathogenic E. coli (ExPEC) isolates worldwide. Retrospective studies have suggested that it may originally have risen to prominence as early as 2003. Unlike other classical group B2 ExPEC isolates, ST131 isolates are commonly reported to produce extended-spectrum β-lactamases, such as CTX-M-15, and almost all are resistant to fluoroquinolones. Moreover, ST131 E. coli isolates are considered to be truly pathogenic, due to the spectrum of infections they cause in both community and hospital settings and the large number of virulence-associated genes they contain. ST131 isolates therefore seem to contradict the widely held view that high levels of antimicrobial resistance are necessarily associated with a fitness cost leading to a decrease in pathogenesis. Six years after the first description of E. coli ST131, this review outlines the principal traits of ST131 clonal group isolates, based on the growing body of published data, and highlights what is currently known and what we need to find out to provide public health authorities with better information to help combat ST131.

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Molecular epidemiology of extraintestinal pathogenic Escherichia coli isolates from a regional cohort of elderly patients highlights the prevalence of ST131 strains with increased antimicrobial resistance in both community and hospital care settings

Cited by 91 publications

References 22 publications

Characterization of Escherichia coli Isolates from Hospital Inpatients or Outpatients with Urinary Tract Infection

Characterization of Escherichia coli Isolates from Hospital Inpatients or Outpatients with Urinary Tract Infection

Prevalence and Characteristics of the Epidemic Multiresistant Escherichia coli ST131 Clonal Group among Extended-Spectrum Beta-Lactamase-Producing E. coli Isolates in Copenhagen, Denmark

Escherichia coli ST131, an Intriguing Clonal Group

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