Self-reported risk factors for having Escherichia coli sequence type 131 or its H30 subclone among US Veterans with a clinical E. coli isolate

AbstractAmong 469 US military veterans with an Escherichia coli clinical isolate (2012–2013), we explored healthcare and non-healthcare risk factors for having E. coli sequence type 131 and its H30 subclone (ST131-H30). Overall, 66 (14%) isolates were ST131; 51 (77%) of these were ST131-H30. After adjustment for healthcare-associated factors, ST131 remained positively associated with medical lines and nursing home residence. After adjustment for environmental factors, ST131 remained associated with wild animal contact (positive), meat consumption (negative) and pet cat exposure (negative). Thus, ST131 was associated predominantly with healthcare-associated exposures, while non-ST131 E. coli were associated with some environmental exposures.

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Long-Term Care Facilities Are Reservoirs for Antimicrobial-Resistant Sequence Type 131 Escherichia coli

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv011 ◽

2015 ◽

Vol 2 (1) ◽

Cited By ~ 25

Author(s):

Mary J. Burgess ◽

James R. Johnson ◽

Stephen B. Porter ◽

Brian Johnston ◽

Connie Clabots ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Gel Electrophoresis ◽

Long Term Care ◽

Pulsed Field Gel Electrophoresis ◽

Sequence Type ◽

Term Care ◽

E Coli ◽

Care Facilities

Abstract Background. Emerging data implicate long-term care facilities (LTCFs) as reservoirs of fluoroquinolone-resistant (FQ-R) Escherichia coli of sequence type 131 (ST131). We screened for ST131 among LTCF residents, characterized isolates molecularly, and identified risk factors for colonization. Methods. We conducted a cross-sectional study using a single perianal swab or stool sample per resident in 2 LTCFs in Olmsted County, Minnesota, from April to July 2013. Confirmed FQ-R E. coli isolates underwent polymerase chain reaction-based phylotyping, detection of ST131 and its H30 and H30-Rx subclones, extended virulence genotyping, and pulsed-field gel electrophoresis (PFGE) analysis. Epidemiological data were collected from medical records. Results. Of 133 fecal samples, 33 (25%) yielded FQ-R E. coli, 32 (97%) of which were ST131. The overall proportion with ST131 intestinal colonization was 32 of 133 (24%), which differed by facility: 17 of 41 (42%) in facility 1 vs 15 of 92 (16%) in facility 2 (P = .002). All ST131 isolates represented the H30 subclone, with virulence gene and PFGE profiles resembling those of previously described ST131 clinical isolates. By PFGE, certain isolates clustered both within and across LTCFs. Multivariable predictors of ST131 colonization included inability to sign consent (odds ratio [OR], 4.16 [P = .005]), decubitus ulcer (OR, 4.87 [ P = .04]), and fecal incontinence (OR, 2.59 [P = .06]). Conclusions. Approximately one fourth of LTCF residents carried FQ-R ST131 E. coli resembling ST131 clinical isolates. Pulsed-field gel electrophoresis suggested intra- and interfacility transmission. The identified risk factors suggest that LTCF residents who require increased nursing care are at greatest risk for ST131 colonization, possibly due to healthcare-associated transmission.

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Trends in Prevalence of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli Isolated From Patients With Community- And Healthcare-Associated Bacteriuria: Results From 2014 To 2020 In An Urban Safety-Net Healthcare System

10.21203/rs.3.rs-150328/v1 ◽

2021 ◽

Author(s):

Eva Raphael ◽

Maria Glymour ◽

Henry F Chambers

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Safety Net ◽

Male Gender ◽

Beta Lactamase ◽

Extended Spectrum Beta Lactamase ◽

E Coli ◽

Race Ethnicity ◽

Healthcare Associated ◽

Community Onset

Abstract BackgroundThe prevalence of infections caused by extended-spectrum beta-lactamase producing Escherichia coli (ESBL-E. coli) is increasing worldwide, but the setting in which this increase is occurring is not well defined. We compared trends and risk factors for ESBL-E. coli bacteriuria in community vs healthcare settings.MethodsWe collected electronic health record data on all patients with E. coli isolated from urine cultures in a safety-net public healthcare system from January 2014 to March 2020. All analyses were stratified by healthcare-onset/associated (bacteriuria diagnosed > 48 hours after hospital admission or in an individual hospitalized in the past 90 days or in a skilled nursing facility resident, N=1,277) or community-onset bacteriuria (all other, N=7,751). We estimated marginal trends from logistic regressions to evaluate annual change in prevalence of ESBL-E. coli bacteriuria among all bacteriuria. We evaluated risk factors using logistic regression models.ResultsESBL-E. coli prevalence increased in both community-onset (0.91% per year, 95% CI: 0.56%, 1.26%) and healthcare-onset/associated (2.31% per year, CI: 1.01%, 3.62%) bacteriuria. In multivariate analyses, age >65 (RR 1.88, CI: 1.17, 3.05), male gender (RR 2.12, CI: 1.65, 2.73), and Latinx race/ethnicity (RR 1.52, CI: 0.99, 2.33) were associated with community-onset ESBL-E. coli. Only male gender (RR 1.53, CI: 1.03, 2.26) was associated with healthcare-onset/associated ESBL-E. coli.ConclusionsESBL-E. coli bacteriuria frequency increased at a faster rate in healthcare-associated settings than in the community between 2004 to 2020. Male gender was associated with ESBL-E. coli bacteriuria in both settings, but additional risks—age >65 and Latinx race/ethnicity—were observed only in the community.

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Whole genome sequencing detects minimal clustering among Escherichia coli Sequence Type 131 H30 isolates collected from U.S. children’s hospitals

10.1101/19010140 ◽

2019 ◽

Author(s):

Arianna Miles-Jay ◽

Scott J. Weissmann ◽

Amanda L. Adler ◽

Janet G. Baseman ◽

Danielle M. Zerr

Keyword(s):

Escherichia Coli ◽

Whole Genome Sequencing ◽

Genome Sequencing ◽

Sequence Type ◽

Whole Genome ◽

E Coli ◽

Geographic Clustering ◽

Healthcare Associated ◽

The U.S ◽

Hospital Transmission

AbstractEscherichia coli sequence type 131 H30 has garnered global attention as a dominant antimicrobial-resistant lineage of extraintestinal pathogenic E. coli, but its transmission dynamics remain undefined. We applied whole genome sequencing to identify putative transmission clusters among clinical isolates of H30 from children across the U.S. Of 126 isolates, 17 were involved in 8 putative transmission clusters; 4 clusters involved isolates with some evidence of healthcare-associated epidemiologic linkages. Geographic clustering analyses showed weak geographic clustering. These findings are consistent with a framework where within-hospital transmission is not a main contributor to the propagation of H30 in a pediatric setting.

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Bacteraemia due to non-ESBL-producing Escherichia coli O25b:H4 sequence type 131: insights into risk factors, clinical features and outcomes

International Journal of Antimicrobial Agents ◽

10.1016/j.ijantimicag.2016.12.013 ◽

2017 ◽

Vol 49 (4) ◽

pp. 498-502 ◽

Cited By ~ 10

Author(s):

Isabel Morales-Barroso ◽

Lorena López-Cerero ◽

José Molina ◽

Mar Bellido ◽

María Dolores Navarro ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Clinical Features ◽

Sequence Type

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Two Novel Mutations Associated with Polymyxin-B Resistance in a Pandemic Lineage of Uropathogenic Escherichia coli of the Sequence Type 69

Chemotherapy ◽

10.1159/000517817 ◽

2021 ◽

pp. 1-7

Author(s):

Carla Adriana dos Santos ◽

Rodrigo Tavanelli Hernandes ◽

Marcos Paulo Vieira Cunha ◽

Filipe Onishi Nagamori ◽

Claudia Regina Gonçalves ◽

...

Keyword(s):

Escherichia Coli ◽

Susceptibility Testing ◽

Polymyxin B ◽

Antimicrobial Treatment ◽

Sequence Type ◽

Broth Microdilution ◽

Economic Costs ◽

Novel Mutations ◽

E Coli ◽

Total Inhibition

Background: Uropathogenic Escherichia coli (UPEC) are frequent pathogens worldwide, impacting on the morbidity and economic costs associated with antimicrobial treatment. Objectives: We report two novel mutations associated with polymyxin-B resistance in an UPEC isolate collected in 2019. Methods: Isolate was submitted to antimicrobial susceptibility testing including broth microdilution for polymyxin B. Whole genome was sequenced and analyzed. Results: Polymyxin-B total inhibition occurred at 16 mg/L (resistant). UPEC isolate was assigned to the phylogroup D, serotype O117:H4, and Sequence Type 69. mcr genes were not detected, but two novel mutations in the pmrA/basS (A80S) and pmrB/basR (D149N) genes were identified. Conclusions: The occurrence of non-mcr polymyxin resistance in E. coli from extraintestinal infections underscores the need of a continuous surveillance of this evolving pathogen.

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A New Clone Sweeps Clean: the Enigmatic Emergence of Escherichia coli Sequence Type 131

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02824-14 ◽

2014 ◽

Vol 58 (9) ◽

pp. 4997-5004 ◽

Cited By ~ 136

Author(s):

Ritu Banerjee ◽

James R. Johnson

Keyword(s):

Escherichia Coli ◽

Sequence Type ◽

Rapid Expansion ◽

Future Research ◽

Content Type ◽

Extended Spectrum Beta Lactamase ◽

E Coli ◽

Phylogenetic Studies ◽

Ecological Success

ABSTRACTEscherichia colisequence type 131 (ST131) is an extensively antimicrobial-resistantE. coliclonal group that has spread explosively throughout the world. Recent molecular epidemiologic and whole-genome phylogenetic studies have elucidated the fine clonal structure of ST131, which comprises multiple ST131 subclones with distinctive resistance profiles, including the (nested) H30, H30-R, and H30-Rx subclones. The most prevalent ST131 subclone, H30, arose from a single common fluoroquinolone (FQ)-susceptible ancestor containing allele 30 offimH(type 1 fimbrial adhesin gene). An early H30 subclone member acquired FQ resistance and launched the rapid expansion of the resulting FQ-resistant subclone, H30-R. Subsequently, a member of H30-R acquired the CTX-M-15 extended-spectrum beta-lactamase and launched the rapid expansion of the CTX-M-15-containing subclone within H30-R, H30-Rx. Clonal expansion clearly is now the dominant mechanism for the rising prevalence of both FQ resistance and CTX-M-15 production in ST131 and inE. coligenerally. Reasons for the successful dissemination and expansion of the key ST131 subclones remain undefined but may include increased transmissibility, greater ability to colonize and/or persist in the intestine or urinary tract, enhanced virulence, and more-extensive antimicrobial resistance compared to otherE. coli. Here we discuss the epidemiology and molecular phylogeny of ST131 and its key subclones, possible mechanisms for their ecological success, implications of their widespread dissemination, and future research needs.

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Impact of Extended-Spectrum β-Lactamase Production on Treatment Outcomes of Acute Pyelonephritis Caused by Escherichia coli in Patients without Health Care-Associated Risk Factors

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.04821-14 ◽

2015 ◽

Vol 59 (4) ◽

pp. 1962-1968 ◽

Cited By ~ 13

Author(s):

Sun Hee Park ◽

Su-Mi Choi ◽

Dong-Gun Lee ◽

Sung-Yeon Cho ◽

Hyo-Jin Lee ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Health Care ◽

Treatment Outcomes ◽

Acute Pyelonephritis ◽

Esbl Production ◽

Content Type ◽

E Coli ◽

Extended Spectrum ◽

The Impact

ABSTRACTExtended-spectrum β-lactamase-producingEscherichia coli(ESBL-EC) is increasingly identified as a cause of acute pyelonephritis (APN) among patients without recent health care contact, i.e., community-associated APN. This case-control study compared 75 cases of community-associated ESBL-EC APN (CA-ESBL) to 225 controls of community-associated non-ESBL-EC APN (CA-non-ESBL) to identify the risk factors for ESBL-EC acquisition and investigate the impact of ESBL on the treatment outcomes of community-associated APN (CA-APN) caused byE. coliat a Korean hospital during 2007 to 2013. The baseline characteristics were similar between the cases and controls; the risk factors for ESBL-EC were age (>55 years), antibiotic use within the previous year, and diabetes with recurrent APN. The severity of illness did not differ between CA-ESBL and CA-non-ESBL (Acute Physiology and Chronic Health Evaluation [APACHE] II scores [mean ± standard deviation], 7.7 ± 5.9 versus 6.4 ± 5.3;P= 0.071). The proportions of clinical (odds ratio [OR], 1.76; 95% confidence interval [CI], 0.57 to 5.38;P= 0.323) and microbiological (OR, 1.16; 95% CI, 0.51 to 2.65;P= 0.730) cures were similar, although the CA-ESBL APN patients were less likely to receive appropriate antibiotics within 48 h. A multivariable Cox proportional hazards analysis of the prognostic factors for CA-APN caused byE. colishowed that ESBL production was not a significant factor for clinical (hazard ratio [HR], 0.39; 95% CI, 0.12 to 1.30;P= 0.126) or microbiological (HR, 0.49; 95% CI, 0.21 to 1.12;P= 0.091) failure. The estimates did not change after incorporating weights calculated using propensity scores for acquiring ESBL-EC. Therefore, ESBL production did not negatively affect treatment outcomes among patients with community-associatedE. coliAPN.

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Bacterial genotypic and patient risk factors for adverse outcomes in Escherichia coli bloodstream infections: a prospective molecular-epidemiological study

10.1101/2021.06.18.21258557 ◽

2021 ◽

Author(s):

Elita Jauneikaite ◽

Kate Honeyford ◽

Oliver Blandy ◽

Mia Mosavie ◽

Max Pearson ◽

...

Keyword(s):

Escherichia Coli ◽

Length Of Stay ◽

Single Agent ◽

Bloodstream Infections ◽

Outcome Data ◽

Sequence Type ◽

Adverse Outcomes ◽

Beta Lactam ◽

E Coli ◽

Sequence Types

Background Escherichia coli bloodstream infections have increased rapidly in the UK, for reasons that are unclear. The relevance of highly fit, or multi-drug resistant lineages such as ST131 to overall E. coli disease burden remains to be fully determined. We set out to characterise the prevalence of E. coli multi-locus sequence types (MLST) and determine if these were associated with adverse outcomes in an urban population of E. coli bacteraemia patients. Methods We undertook whole genome sequencing of E. coli blood isolates from all patients with diagnosed E. coli bacteraemia in north-west London from July 2015 to August 2016 and assigned multi-locus sequence types to all isolates. Isolate sequence types were linked to routinely collected antimicrobial susceptibility, patient demographic, and clinical outcome data to explore relationships between the E. coli sequence types, patient factors, and outcomes. Findings A total of 551 E. coli genomes were available for analysis. More than half of these cases were caused by four E. coli sequence types: ST131 (21%), ST73 (15%), ST69 (9%) and ST95 (8%). E. coli genotype ST131-C2 was associated with non-susceptibility to quinolones and third-generation cephalosporins, and also to amoxicillin, augmentin, gentamicin and trimethoprim. An association between the ST131-C2 lineage and longer length-of-stay was detected, although multivariable regression modelling did not demonstrate an association between E. coli sequence type and mortality. However, a number of unexpected associations were identified, including gentamicin non-susceptibility, ethnicity, and sex that might influence mortality and length-of-stay, requiring further research. Interpretation Although E. coli sequence type was associated with antimicrobial non-susceptibility patterns and length-of-stay, we did not find that E. coli sequence type was associated with increased mortality. Where ST131 is prevalent, caution is required when pairing beta-lactam agents with gentamicin or using single agent aminoglycosides.

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The Emergence of Quaternary Ammonium Compounds Resistance in Escherichia coli Isolated from Hospitals of Qazvin, Iran

Infectious Disorders - Drug Targets ◽

10.2174/1871526519666191009145825 ◽

2020 ◽

Vol 20 (4) ◽

pp. 455-460

Author(s):

Narges Habibollah-Pourzereshki ◽

Amir Peymani ◽

Fatemeh Keshavarz-Saleh

Keyword(s):

Escherichia Coli ◽

Infection Control ◽

Critical Issue ◽

Cross Sectional Study ◽

Resistance Rate ◽

Healthcare Associated Infection ◽

Cross Sectional ◽

E Coli ◽

Healthcare Associated ◽

Ammonium Compounds

Introduction: Escherichia coli is one of the most important agents involved in healthcare-associated infection, and resistance to quantum ammonium compounds (QACs) has become a major challenge for infection control practitioners. The aim of the current study was to determine the frequency of qacE and qacEΔ1 genes in E. coli isolated from hospitalized patients in Qazvin, Iran. Material and Methods: In the current cross-sectional study, 102 E. coli were collected from hospitals of Qazvin. All bacterial isolates were identified using standard laboratory methods and the antimicrobial susceptibility was evaluated by Kirby-Baer test. The presence of qacE and qacEΔ1 genes was investigated using polymerase chain reaction (PCR) technique. Results: In this study, 65 (63.7%) isolates showed a multidrug resistance (MDR) pattern which was resistant to at least three classes of antimicrobials including ß-lactams, aminoglycosides, and fluoroquinolones. The highest rates of resistance were observed against cefotaxime (75.5%) and nalidixic acid (66.7%). The PCR showed that 5 (4.9%) isolates harbored qacE gene, 62 (60.8%) isolates qacEΔ1, and 10 (9.8%) isolates carried both genes, simultaneously. There was a significant relationship between the QACs resistance and MDR pattern (P=0.03). Conclusion: This study indicated a significant resistance rate against disinfectant compounds in the studied hospitals. However, more attention should be paid to this critical issue in the infection control committees of the hospitals.

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Genotypic and Phenotypic Profiles of Escherichia coli Isolates Belonging to Clinical Sequence Type 131 (ST131), Clinical Non-ST131, and Fecal Non-ST131 Lineages from India

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.03320-14 ◽

2014 ◽

Vol 58 (12) ◽

pp. 7240-7249 ◽

Cited By ~ 41

Author(s):

Arif Hussain ◽

Amit Ranjan ◽

Nishant Nandanwar ◽

Anshu Babbar ◽

Savita Jadhav ◽

...

Keyword(s):

Escherichia Coli ◽

Sequence Type ◽

Care Hospital ◽

Zebra Fish ◽

Esbl Production ◽

Sensitivity Testing ◽

Metabolic Potential ◽

Content Type ◽

E Coli ◽

Antimicrobial Resistance Gene

ABSTRACTIn view of the epidemiological success of CTX-M-15-producing lineages ofEscherichia coliand particularly of sequence type 131 (ST131), it is of significant interest to explore its prevalence in countries such as India and to determine if antibiotic resistance, virulence, metabolic potential, and/or the genetic architecture of the ST131 isolates differ from those of non-ST131 isolates. A collection of 126E. coliisolates comprising 43 ST131E. coli, 40 non-ST131E. coli, and 43 fecalE. coliisolates collected from a tertiary care hospital in India was analyzed. These isolates were subjected to enterobacterial repetitive intergenic consensus (ERIC)-based fingerprinting, O typing, phylogenetic grouping, antibiotic sensitivity testing, and virulence and antimicrobial resistance gene (VAG) detection. Representative isolates from this collection were also analyzed by multilocus sequence typing (MLST), conjugation, metabolic profiling, biofilm production assay, and zebra fish lethality assay. All of the 43 ST131E. coliisolates were exclusively associated with phylogenetic group B2 (100%), while most of the clinical non-ST131 and stool non-ST131E. coliisolates were affiliated with the B2 (38%) and A (58%) phylogenetic groups, respectively. Significantly greater proportions of ST131 isolates (58%) than non-ST131 isolates (clinical and stoolE. coliisolates, 5% each) were technically identified to be extraintestinal pathogenicE. coli(ExPEC). The clinical ST131, clinical non-ST131, and stool non-ST131E. coliisolates exhibited high rates of multidrug resistance (95%, 91%, and 91%, respectively), extended-spectrum-β-lactamase (ESBL) production (86%, 83%, and 91%, respectively), and metallo-β-lactamase (MBL) production (28%, 33%, and 0%, respectively). CTX-M-15 was strongly linked with ESBL production in ST131 isolates (93%), whereas CTX-M-15 plus TEM were present in clinical and stool non-ST131E. coliisolates. Using MLST, we confirmed the presence of two NDM-1-positive ST131E. coliisolates. The aggregate bioscores (metabolite utilization) for ST131, clinical non-ST131, and stool non-ST131E. coliisolates were 53%, 52%, and 49%, respectively. The ST131 isolates were moderate biofilm producers and were more highly virulent in zebra fish than non-ST131 isolates. According to ERIC-based fingerprinting, the ST131 strains were more genetically similar, and this was subsequently followed by the genetic similarity of clinical non-ST131 and stool non-ST131E. colistrains. In conclusion, our data provide novel insights into aspects of the fitness advantage ofE. colilineage ST131 and suggest that a number of factors are likely involved in the worldwide dissemination of and infections due to ST131E. coliisolates.

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