Transmission of an Extended-Spectrum-Beta-Lactamase-Producing
            <i>Escherichia coli</i>
            (Sequence Type ST131) Strain between a Father and Daughter Resulting in Septic Shock and Emphysematous Pyelonephritis

Ender, Peter T.; Gajanana, Deepakraj; Johnston, Brian; Clabots, Connie; Tamarkin, Frank J.; Johnson, James R.

doi:10.1128/jcm.01361-09

Cited by 66 publications

(51 citation statements)

References 7 publications

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“…coli ST131 isolates from around the world have been reported to closely resemble one another genotypically, suggesting rapid, global dissemination. This has been attributed to multiple factors, including direct human-to-human transmission (12), international travel (37), environmental dissemination (43), fecal carriage in livestock (and spread via raw meats) (46), and carriage by domestic (13,24) or wild (15) animals. Our findings support the concept that companion animals probably participate in the dissemination of ST131 strains of human relevance.…”

Section: Discussionmentioning

confidence: 99%

Commonality among Fluoroquinolone-Resistant Sequence Type ST131 Extraintestinal Escherichia coli Isolates from Humans and Companion Animals in Australia

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Johnson

et al. 2011

Antimicrob Agents Chemother

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Escherichia coli sequence type 131 (ST131), an emergent multidrug-resistant extraintestinal pathogen, has spread epidemically among humans and was recently isolated from companion animals. To assess for humancompanion animal commonality among ST131 isolates, 214 fluoroquinolone-resistant extraintestinal E. coli isolates (205 from humans, 9 from companion animals) from diagnostic laboratories in Australia, provisionally identified as ST131 by PCR, selectively underwent PCR-based O typing and bla CTX-M-15 detection. A subset then underwent multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE) analysis, extended virulence genotyping, antimicrobial susceptibility testing, and fluoroquinolone resistance genotyping. All isolates were O25b positive, except for two O16 isolates and one O157 isolate, which (along with six O25b-positive isolates) were confirmed by MLST to be ST131. Only 12% of isolates (25 human, 1 canine) exhibited bla CTX-M-15 . PFGE analysis of 20 randomly selected human and all 9 companion animal isolates showed multiple instances of >94% profile similarity across host species; 12 isolates (6 human, 6 companion animal) represented pulsotype 968, the most prevalent ST131 pulsotype in North America (representing 23% of a large ST131 reference collection). Virulence gene and antimicrobial resistance profiles differed minimally, without host species specificity. The analyzed ST131 isolates also exhibited a conserved, host species-independent pattern of chromosomal fluoroquinolone resistance mutations. However, eight (89%) companion animal isolates, versus two (10%) human isolates, possessed the plasmid-borne qnrB gene (P < 0.001). This extensive across-species strain commonality, plus the similarities between Australian and non-Australian ST131 isolates, suggest that ST131 isolates are exchanged between humans and companion animals both within Australia and intercontinentally.

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Section: Discussionmentioning

confidence: 99%

Commonality among Fluoroquinolone-Resistant Sequence Type ST131 Extraintestinal Escherichia coli Isolates from Humans and Companion Animals in Australia

Platell

Cobbold

Johnson

et al. 2011

Antimicrob Agents Chemother

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112

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“…ST131 transmission has essentially been documented between members of the same household and between family members and pets (dogs and cats in particular) (124). Ender et al provided strong evidence of the transmission of a CTX-M-15-producing ST131 isolate resistant to gentamicin, trimethoprim-sulfamethoxazole, and fluoroquinolones between a father and his daughter (122). The father was admitted to a hospital for pyelonephritis due to a clone ST131 strain, where he was visited by his adult daughter.…”

Section: Pathogenic Characteristicsmentioning

confidence: 99%

“…E. coli ST131 strains cause community-and hospital-acquired UTI (cystitis and pyelonephritis) and bacteremia worldwide (42,109,118). They have also been reported to cause other types of infection: intra-abdominal and soft tissue infections (54), meningitis (119), osteoarticular infection (120), myositis (121), epididymo-orchitis (119), and septic shock (122,123). This spectrum of infections, typical of ExPEC, has increased the degree of concern about ST131, which is already considered a major potential problem due to its multidrug resistance.…”

Section: Pathogenic 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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“…Within-household sharing of E. coli strains, including members of sequence type ST131, among human and animal household members has been extensively documented (2,4,8). This process, which likely reflects host-to-host transmission, may contribute significantly to the community-wide dissemination of emerging antimicrobial-resistant uropathogenic E. coli lineages, such as clonal group A (trimethoprim-sulfamethoxazole resistance) (7,9), the O15:K52:H1 clonal group (fluoroquinolone resistance) (7), and perhaps of greatest concern, ST131 (fluoroquinolone and extended-spectrum cephalosporin resistance) (5,12,13).…”

Section: Case Reportmentioning

confidence: 99%

Community Transmission in the United States of a CTX-M-15-Producing Sequence Type ST131 Escherichia coli Strain Resulting in Death

et al. 2011

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A middle-aged woman developed fatal urosepsis due to a multidrug-resistant Escherichia coli strain representing sequence type ST131, a recently emerged, disseminated, multidrug-resistant extraintestinal pathogen, after presumably having acquired it from her extensively antibiotic-exposed sister with chronic recurrent cystitis. Susceptibility results (reported on day 4) showed resistance to the initially selected regimen. CASE REPORTThe index patient was a middle-aged female with chronic, recurrent symptomatic urinary tract infections (UTIs) due to Escherichia coli. Her urine isolates had become increasingly antimicrobial resistant over a 5-year period, including having become, for the past several years, extended-spectrum betalactamase (ESBL) positive.Both the index patient and a younger sister had alpha-1-antitrypsin deficiency. Whereas the index patient was only mildly affected, the younger sister was severely affected, leading to long-term care facility placement and a referral for lung transplantation (which was denied, because of continued smoking). The index patient had cared for the younger sister in the index patient's home for several months during the summer prior to the younger sister's acute illness.Shortly after the younger sister's temporary residence in the index patient's home, she began to experience mild dysuria when voiding (no indwelling or intermittent urinary catheter use) and low-grade fever. After a week of progressive symptoms, she was admitted to the hospital for presumed pyelonephritis.On admission, the patient appeared to be in mild distress with right-sided flank pain. Her temperature was 37.6°C, pulse was 52 beats per minute, blood pressure was 153/82 mm Hg, and respirations were 24 per minute. Oxyhemoglobin saturation was 92% on 4 liters of oxygen. The right flank was tender. Laboratory findings included leukocytosis (17,800 cells/l) with 88% neutrophils. Urinalysis showed marked pyuria and bacteriuria. Ciprofloxacin (400 mg intravenously every 12 h) and stress-dose corticosteroids were administered.Over 3 days, her clinical status worsened, and she was transferred to the intensive care unit for septic shock, presumed to be secondary to pyelonephritis. Her white blood cell (WBC) count rose to 18,400 cells/l (29% band forms), and her serum creatinine level increased to 2.7 mg/dl. The patient received mechanical ventilation and vasopressor therapy. Renal ultrasonography revealed moderate right hydronephrosis; a right percutaneous nephrostomy tube was placed. Blood and urine cultures grew E. coli.Due to the patient's precipitous decline, antimicrobial therapy was broadened empirically by adding piperacillin-tazobactam, based on local antibiogram data. On hospital day 4, septic shock worsened, requiring additional vasopressor support. Susceptibility data, which were now reported, showed the E. coli isolates to be resistant to fluoroquinolones and extended-spectrum cephalosporins but susceptible to piperacillin-tazobactam, amikacin, carbapenems, and trimethoprim-sulfamethoxazole. Therap...

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Transmission of an Extended-Spectrum-Beta-Lactamase-Producing Escherichia coli (Sequence Type ST131) Strain between a Father and Daughter Resulting in Septic Shock and Emphysematous Pyelonephritis

Cited by 66 publications

References 7 publications

Commonality among Fluoroquinolone-Resistant Sequence Type ST131 Extraintestinal Escherichia coli Isolates from Humans and Companion Animals in Australia

Commonality among Fluoroquinolone-Resistant Sequence Type ST131 Extraintestinal Escherichia coli Isolates from Humans and Companion Animals in Australia

Escherichia coli ST131, an Intriguing Clonal Group

Community Transmission in the United States of a CTX-M-15-Producing Sequence Type ST131 Escherichia coli Strain Resulting in Death

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