Incidence of Extended-Spectrum β-Lactamase (ESBL)-Producing Escherichia coli and Klebsiella Infections in the United States: A Systematic Literature Review

BACKGROUNDDespite a reported worldwide increase, the incidence of extended-spectrum β-lactamase (ESBL) Escherichia coli and Klebsiella infections in the United States is unknown. Understanding the incidence and trends of ESBL infections will aid in directing research and prevention efforts.OBJECTIVETo perform a literature review to identify the incidence of ESBL-producing E. coli and Klebsiella infections in the United States.DESIGNSystematic literature review.METHODSMEDLINE via Ovid, CINAHL, Cochrane library, NHS Economic Evaluation Database, Web of Science, and Scopus were searched for multicenter (≥2 sites), US studies published between 2000 and 2015 that evaluated the incidence of ESBL-E. coli or ESBL-Klebsiella infections. We excluded studies that examined resistance rates alone or did not have a denominator that included uninfected patients such as patient days, device days, number of admissions, or number of discharges. Additionally, articles that were not written in English, contained duplicated data, or pertained to ESBL organisms from food, animals, or the environment were excluded.RESULTSAmong 51,419 studies examined, 9 were included for review. Incidence rates differed by patient population, time, and ESBL definition and ranged from 0 infections per 100,000 patient days to 16.64 infections per 10,000 discharges and incidence rates increased over time from 1997 to 2011. Rates were slightly higher for ESBL-Klebsiella infections than for ESBL-E. coli infections.CONCLUSIONThe incidence of ESBL-E. coli and ESBL-Klebsiella infections in the United States has increased, with slightly higher rates of ESBL-Klebsiella infections. Appropriate estimates of ESBL infections when coupled with other mechanisms of resistance will allow for the appropriate targeting of resources toward research, drug discovery, antimicrobial stewardship, and infection prevention.Infect Control Hosp Epidemiol 2017;38:1209–1215

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Genetic Determinants of Resistance to Extended-Spectrum Cephalosporin and Fluoroquinolone in Escherichia coli Isolated from Diseased Pigs in the United States

mSphere ◽

10.1128/msphere.00990-20 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Shivdeep Singh Hayer ◽

Seunghyun Lim ◽

Samuel Hong ◽

Ehud Elnekave ◽

Timothy Johnson ◽

...

Keyword(s):

United States ◽

Escherichia Coli ◽

High Risk ◽

The United States ◽

Genetic Determinants ◽

Content Type ◽

E Coli ◽

Extended Spectrum ◽

Animal Populations ◽

Swine Population

ABSTRACT Fluoroquinolones and cephalosporins are critically important antimicrobial classes for both human and veterinary medicine. We previously found a drastic increase in enrofloxacin resistance in clinical Escherichia coli isolates collected from diseased pigs from the United States over 10 years (2006 to 2016). However, the genetic determinants responsible for this increase have yet to be determined. The aim of the present study was to identify and characterize the genetic basis of resistance against fluoroquinolones (enrofloxacin) and extended-spectrum cephalosporins (ceftiofur) in swine E. coli isolates using whole-genome sequencing (WGS). blaCMY-2 (carried by IncA/C2, IncI1, and IncI2 plasmids), blaCTX-M (carried by IncF, IncHI2, and IncN plasmids), and blaSHV-12 (carried by IncHI2 plasmids) genes were present in 87 (82.1%), 19 (17.9%), and 3 (2.83%) of the 106 ceftiofur-resistant isolates, respectively. Of the 110 enrofloxacin-resistant isolates, 90 (81.8%) had chromosomal mutations in gyrA, gyrB, parA, and parC genes. Plasmid-mediated quinolone resistance genes [qnrB77, qnrB2, qnrS1, qnrS2, and aac-(6)-lb′-cr] borne on ColE, IncQ2, IncN, IncF, and IncHI2 plasmids were present in 24 (21.8%) of the enrofloxacin-resistant isolates. Virulent IncF plasmids present in swine E. coli isolates were highly similar to epidemic plasmids identified globally. High-risk E. coli clones, such as ST744, ST457, ST131, ST69, ST10, ST73, ST410, ST12, ST127, ST167, ST58, ST88, ST617, ST23, etc., were also found in the U.S. swine population. Additionally, the colistin resistance gene (mcr-9) was present in several isolates. This study adds valuable information regarding resistance to critical antimicrobials with implications for both animal and human health. IMPORTANCE Understanding the genetic mechanisms conferring resistance is critical to design informed control and preventive measures, particularly when involving critically important antimicrobial classes such as extended-spectrum cephalosporins and fluoroquinolones. The genetic determinants of extended-spectrum cephalosporin and fluoroquinolone resistance were highly diverse, with multiple plasmids, insertion sequences, and genes playing key roles in mediating resistance in swine Escherichia coli. Plasmids assembled in this study are known to be disseminated globally in both human and animal populations and environmental samples, and E. coli in pigs might be part of a global reservoir of key antimicrobial resistance (AMR) elements. Virulent plasmids found in this study have been shown to confer fitness advantages to pathogenic E. coli strains. The presence of international, high-risk zoonotic clones provides worrisome evidence that resistance in swine isolates may have indirect public health implications, and the swine population as a reservoir for these high-risk clones should be continuously monitored.

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Editorial Commentary: Extended-Spectrum -Lactamase-Producing Escherichia coli in the United States: Time to Rethink Empirical Treatment for Suspected E. coli Infections?

Clinical Infectious Diseases ◽

10.1093/cid/cis947 ◽

2012 ◽

Vol 56 (5) ◽

pp. 649-651 ◽

Cited By ~ 10

Author(s):

B. Foxman

Keyword(s):

United States ◽

Escherichia Coli ◽

The United States ◽

Empirical Treatment ◽

E Coli ◽

Editorial Commentary ◽

Extended Spectrum

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Molecular Characterization of Resistance to Extended-Spectrum Cephalosporins in Clinical Escherichia coli Isolates from Companion Animals in the United States

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00656-11 ◽

2011 ◽

Vol 55 (12) ◽

pp. 5666-5675 ◽

Cited By ~ 60

Author(s):

Bashar W. Shaheen ◽

Rajesh Nayak ◽

Steven L. Foley ◽

Ohgew Kweon ◽

Joanna Deck ◽

...

Keyword(s):

United States ◽

Escherichia Coli ◽

Regulatory Region ◽

Companion Animals ◽

The United States ◽

Conjugative Plasmid ◽

Chromosomal Gene ◽

Content Type ◽

E Coli ◽

Extended Spectrum

ABSTRACTResistance to extended-spectrum cephalosporins (ESC) among members of the familyEnterobacteriaceaeoccurs worldwide; however, little is known about ESC resistance inEscherichia colistrains from companion animals. Clinical isolates ofE. coliwere collected from veterinary diagnostic laboratories throughout the United States from 2008 to 2009.E. coliisolates (n= 54) with reduced susceptibility to ceftazidime or cefotaxime (MIC ≥ 16 μg/ml) and extended-spectrum-β-lactamase (ESBL) phenotypes were analyzed. PCR and sequencing were used to detect mutations in ESBL-encoding genes and the regulatory region of the chromosomal geneampC. Conjugation experiments and plasmid identification were conducted to examine the transferability of resistance to ESCs. All isolates carried theblaCTX-M-1-group β-lactamase genes in addition to one or more of the following β-lactamase genes:blaTEM,blaSHV-3,blaCMY-2,blaCTX-M-14-like, andblaOXA-1.DifferentblaTEMsequence variants were detected in some isolates (n= 40). Three isolates harbored ablaTEM-181gene with a novel mutation resulting in an Ala184Val substitution. Approximately 78% of the isolates had mutations in promoter/attenuator regions of the chromosomal geneampC, one of which was a novel insertion of adenine between bases −28 and −29. Plasmids ranging in size from 11 to 233 kbp were detected in the isolates, with a common plasmid size of 93 kbp identified in 60% of isolates. Plasmid-mediated transfer of β-lactamase genes increased the MICs (≥16-fold) of ESCs for transconjugants. Replicon typing among isolates revealed the predominance of IncI and IncFIA plasmids, followed by IncFIB plasmids. This study shows the emergence of conjugative plasmid-borne ESBLs amongE. colistrains from companion animals in the United States, which may compromise the effective therapeutic use of ESCs in veterinary medicine.

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The Pandemic H30 Subclone of Sequence Type 131 (ST131) as the Leading Cause of Multidrug-Resistant Escherichia coli Infections in the United States (2011–2012)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx089 ◽

2017 ◽

Vol 4 (2) ◽

Cited By ~ 33

Author(s):

James R. Johnson ◽

Stephen Porter ◽

Paul Thuras ◽

Mariana Castanheira

Keyword(s):

United States ◽

Escherichia Coli ◽

The United States ◽

Multidrug Resistant ◽

Sequence Type ◽

Source Population ◽

Beta Lactamase ◽

E Coli ◽

Specimen Type ◽

Extended Spectrum

Abstract Background Extraintestinal Escherichia coli infections are increasingly challenging due to emerging antimicrobial resistance, including resistance to extended-spectrum beta-lactams and fluoroquinolones. Sequence type 131 (ST131) is a leading contributor. Methods Three hundred sixty E. coli clinical isolates from across the United States (2011–2012), selected randomly from the SENTRY collection within 3 resistance categories (extended-spectrum cephalosporin [ECS]–reduced susceptibility [RS]; fluoroquinolone-resistant, ESC-susceptible; and fluoroquinolone-susceptible, ESC-susceptible) were typed for phylogroup, sequence type complex (STc), subsets thereof, virulence genotype, O type, and beta-lactamase genes. Molecular results were compared with susceptibility profile, specimen type, age, and sex. Results Phylogroup B2 accounted for most isolates, especially fluoroquinolone-resistant isolates (83%). Group B2–derived ST131 and its H30 subclone (divided between H30Rx and H30R1) predominated, especially among ESC-RS and fluoroquinolone-resistant isolates. In contrast, among fluoroquinolone-susceptible isolates, group B2–derived STc73 and STc95 predominated. Within each resistance category, ST131 isolates exhibited more extensive resistance and/or virulence profiles than non-ST131 isolates. ST131-H30 was distributed broadly by geographical region, age, and specimen type and exhibited distinctive beta-lactamase genes. Back-calculations indicated that within the source population ST131 accounted for 26.4% of isolates overall (vs 17% in 2007), including 19.8% ST131-H30, 13.2% ST131-H30R1, and 6.6% each ST131-H30Rx and non-H30 ST131. Conclusions ST131-H30, with its ESC resistance-associated H30Rx subset, caused most antimicrobial-resistant E. coli infections across the United States in 2011–2012 and, since 2007, increased in relative prevalence by >50%. Focused attention to this strain could help combat the current E. coli resistance epidemic.

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Trends in Antimicrobial Resistance among Urinary Tract Infection Isolates of Escherichia coli from Female Outpatients in the United States

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.46.8.2540-2545.2002 ◽

2002 ◽

Vol 46 (8) ◽

pp. 2540-2545 ◽

Cited By ~ 192

Author(s):

James A. Karlowsky ◽

Laurie J. Kelly ◽

Clyde Thornsberry ◽

Mark E. Jones ◽

Daniel F. Sahm

Keyword(s):

United States ◽

Escherichia Coli ◽

The United States ◽

Initial Therapy ◽

Surveillance Network ◽

E Coli ◽

Testing Data ◽

Institutional Variation ◽

Resistance Rates ◽

Urinary Isolates

ABSTRACT The Infectious Diseases Society of America advocates trimethoprim-sulfamethoxazole (SXT) as initial therapy for females with acute uncomplicated bacterial cystitis in settings where the prevalence of SXT resistance does not exceed 10 to 20%. To determine trends in the activities of SXT, ampicillin, ciprofloxacin, and nitrofurantoin among urine isolates of Escherichia coli from female outpatients, susceptibility testing data from The Surveillance Network (TSN) Database-USA (n = 286,187) from 1995 to 2001 were analyzed. Resistance rates among E. coli isolates to ampicillin (range, 36.0 to 37.4% per year), SXT (range, 14.8 to 17.0%), ciprofloxacin (range, 0.7 to 2.5%), and nitrofurantoin (range, 0.4 to 0.8%) varied only slightly over this 7-year period. Ciprofloxacin was the only agent studied that demonstrated a consistent stepwise increase in resistance from 1995 (0.7%) to 2001 (2.5%). In 2001, SXT resistance among E. coli isolates was >10% in all nine U.S. Bureau of the Census regions. At institutions testing ≥100 urinary isolates of E. coli (n = 126) in 2001, ampicillin (range, 27.3 to 98.8%) and SXT (range, 7.5 to 47.1%) resistance rates varied widely while ciprofloxacin (range, 0 to 12.9%) and nitrofurantoin (range, 0 to 2.8%) resistance rates were more consistent. In 2001, the most frequent coresistant phenotypes were resistance to ampicillin and SXT (12.0% of all isolates; 82.3% of coresistant isolates) and resistance to ampicillin, ciprofloxacin, and SXT (1.4% of all isolates; 9.9% of coresistant isolates). Coresistance less frequently included resistance to nitrofurantoin (3.5% of coresistant isolates) than resistance to ciprofloxacin (15.8%), SXT (95.7%), and ampicillin (98.1%). In conclusion, among urinary isolates of E. coli from female outpatients in the United States, national resistance rates to SXT were relatively consistent (14.8 to 17.0%) from 1995 to 2001 but demonstrated considerable regional and institutional variation in 2001. Therapies other than SXT may need to be considered in some locations.

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2510. Systematic Literature Review of Multiclass Resistance in Heavily Treatment Experienced Persons with HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2188 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S871-S871

Author(s):

Josephine Mauskopf ◽

Maria M Fernandez ◽

Jade Ghosn ◽

Paul Sax ◽

Julie Priest ◽

...

Keyword(s):

United States ◽

Literature Review ◽

Systematic Literature Review ◽

Virologic Failure ◽

The United States ◽

Hiv And Aids ◽

European Countries ◽

Cochrane Library ◽

The Past ◽

Western European

Abstract Background Because of progress in antiretroviral therapy (ART), fewer people with HIV experience virologic failure with multiclass resistance. We sought to estimate the prevalence of multiclass resistance since the introduction of INSTI-based regimens using a systematic literature review. Methods A systematic literature search using PubMed, Embase, and the Cochrane Library was conducted of articles published since 2008, the year when INSTI-based regimens for treatment-experienced people with HIV became widely used. Bibliographies of existing literature reviews, websites of European and International organizations reporting data on HIV and AIDS, and abstracts presented from 2016–2018 at conferences were searched to identify additional relevant studies. Using predefined criteria, two reviewers independently reviewed studies reporting multiclass (three-class or greater) resistance in persons with HIV infection who are treatment experienced and were either perinatally infected or infected as adults. Studies from Western Europe, Australia, Canada and the United States (US) using any type of resistance definitions and resistance tests were included. Results A total of 441 unique articles were identified, 343 were excluded during level 1 screening and 98 articles were included for full-text review. A total of 34 articles (11 US studies, 3 from Canada, 1 from Australia, and 19 from Western European countries.) met the inclusion criteria and were included in data extraction analysis. Over the past decade, a modest decrease in the prevalence of three-class (NNRTI, NRTI, PI) resistance was observed in studies from the United States and Canada, ranging from 8.3% in 2009 to 6.7% in 2014 (Figure 1). Western European countries and Australia showed similar trends. The prevalence of 4-class resistance (including INSTIs) with virologic failure in the current treatment era is low, less than 2% (Figure 2). Conclusion The prevalence of multiclass resistance has decreased over the past decade, with three-class resistance continuing to decline and four-class resistance rare. Although the population with treatment failure and no viable options for a suppressive regimen is currently small, this group of people with HIV are in urgent need of novel treatment options. Disclosures All authors: No reported disclosures.

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

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.05824-11 ◽

2012 ◽

Vol 56 (5) ◽

pp. 2364-2370 ◽

Cited By ~ 83

Author(s):

James R. Johnson ◽

Carl Urban ◽

Scott J. Weissman ◽

James H. Jorgensen ◽

James S. Lewis ◽

...

Keyword(s):

United States ◽

Escherichia Coli ◽

Antimicrobial Resistance ◽

The United States ◽

Sequence Type ◽

Fluoroquinolone Resistance ◽

Convenience Sample ◽

Content Type ◽

E Coli ◽

Extended Spectrum

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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Asian American Older Adults and Social Isolation: A Systematic Literature Review

Innovation in Aging ◽

10.1093/geroni/igaa057.1051 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 328-328

Author(s):

Simona Kwon ◽

Deborah Min ◽

Stella Chong

Keyword(s):

United States ◽

Older Adults ◽

Literature Review ◽

Social Isolation ◽

Asian Americans ◽

Systematic Literature Review ◽

Asian American ◽

Minority Group ◽

The United States ◽

Eligibility Criteria

Abstract Asian Americans are the fastest growing racial and ethnic minority group in the United States, whose population is aging considerably. Previous studies indicate that social isolation and loneliness disproportionately affects older adults and predicts greater physical, mental, and cognitive decline. A systematic literature review using PRISMA guidelines was conducted to address this emerging need to understand the scope of research focused on social isolation and loneliness among the disparity population of older Asian Americans. Four interdisciplinary databases were searched: PubMed, CINAHL, PsycINFO, and AgeLine; search terms included variations on social isolation, loneliness, Asian Americans, and older adults. Articles were reviewed based on six eligibility criteria: (1) research topic relevance, (2) study participants aged >60 years, (3) Asian immigrants as main participants, (4) conducted in the United States, (5) published between 1995-2019, and (6) printed in the English language. The search yielded 799 articles across the four databases and 61 duplicate articles were removed. Abstracts were screened for the 738 remaining studies, 107 of which underwent full-text review. A total of 56 articles met the eligibility criteria. Synthesis of our review indicates that existing research focuses heavily on Chinese and Korean American immigrant communities, despite the heterogeneity of the diverse Asian American population. Studies were largely observational and employed community-based sampling. Critical literature gaps exist surrounding social isolation and loneliness in Asian American older adults, including the lack of studies on South Asian populations. Future studies should prioritize health promotion intervention research and focus on diverse understudied Asian subgroups.

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