Plasmid-Mediated Imipenem-Hydrolyzing Enzyme KPC-2 among Multiple Carbapenem-Resistant Escherichia coli Clones in Israel

ABSTRACT Carbapenem resistance in Escherichia coli is rare. We report four genetically unrelated carbapenem-resistant E. coli isolates cultured from four patients hospitalized in Tel Aviv Medical Center. PCR, sequencing, and Southern blot analysis identified KPC-2 as the imipenem-hydrolyzing enzyme in all four strains, carried on different plasmids with a possible common origin. This is the first discovery of KPC-2 in E. coli and the first report of this enzyme originating outside the United States.

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Activity of Imipenem-Relebactam against Carbapenem-Resistant Escherichia coli Isolates from the United States in Relation to Clonal Background, Resistance Genes, Coresistance, and Region

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02408-19 ◽

2020 ◽

Vol 64 (5) ◽

Cited By ~ 2

Author(s):

Brian D. Johnston ◽

Paul Thuras ◽

Stephen B. Porter ◽

Melissa Anacker ◽

Brittany VonBank ◽

...

Keyword(s):

United States ◽

Escherichia Coli ◽

Carbapenem Resistance ◽

The United States ◽

Resistance Mechanisms ◽

Beta Lactamase ◽

Content Type ◽

E Coli ◽

Highly Active ◽

Carbapenem Resistant

ABSTRACT Imipenem-relebactam (I-R) is a recently developed carbapenem–beta-lactamase inhibitor combination agent that can overcome carbapenem resistance, which has now emerged in Escherichia coli, including sequence type 131 (ST131) and its fluoroquinolone-resistant H30R subclone, the leading cause of extraintestinal E. coli infections globally. To clarify the likely utility of I-R for carbapenem-resistant (CR) E. coli infections in the United States, we characterized 203 recent CR clinical E. coli isolates from across the United States (years 2002 to 2017) for phylogroup, clonal group (including ST131, H30R, and the CTX-M-15-associated H30Rx subset within H30R), relevant beta-lactamase genes, and broth microdilution MICs for I-R and 11 comparator agents. Overall, I-R was highly active (89% susceptible), more so than all comparators except tigecycline and colistin (both 99% susceptible). I-R’s activity varied significantly in relation to phylogroup, clonal background, resistance genotype, and region. It was greatest among phylogroup B2, ST131-H30R, H30Rx, Klebsiella pneumoniae carbapenemase (KPC)-positive, and northeast U.S. isolates and lowest among phylogroup C, New Delhi metallo-β-lactamase (NDM)-positive, and southeast U.S. isolates. Relebactam improved imipenem’s activity against CR isolates within each phylogroup—especially groups A, B1, and B2—and particularly against isolates containing KPC. I-R remained substantially active against isolates coresistant to comparator agents, albeit somewhat less so than against the corresponding susceptible isolates. These findings suggest that I-R should be useful for treating most CR E. coli infections in the United States, largely independent of coresistance, although this likely will vary in relation to the local prevalence of specific E. coli lineages and carbapenem resistance mechanisms.

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Emergence of KPC-2 and KPC-3 in Carbapenem-Resistant Klebsiella pneumoniae Strains in an Israeli Hospital

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00299-07 ◽

2007 ◽

Vol 51 (8) ◽

pp. 3026-3029 ◽

Cited By ~ 167

Author(s):

Azita Leavitt ◽

Shiri Navon-Venezia ◽

Inna Chmelnitsky ◽

Mitchell J. Schwaber ◽

Yehuda Carmeli

Keyword(s):

United States ◽

Klebsiella Pneumoniae ◽

Medical Center ◽

Carbapenem Resistance ◽

The United States ◽

Tel Aviv ◽

Carbapenem Resistant ◽

Single Clone ◽

Rapid Dissemination ◽

Almost All

ABSTRACT Carbapenem resistance due to KPC has rarely been observed outside the United States. We noticed a sharp increase in carbapenem-resistant Klebsiella pneumoniae strains possessing KPC in Tel Aviv Medical Center from 2004 to 2006. Sixty percent of the isolates belonged to a single clone susceptible only to gentamicin and colistin and carried the bla KPC-3 gene, while almost all other clones carried the bla KPC-2 gene. This rapid dissemination of KPC outside the United States is worrisome.

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Complete Genome Sequence of a Carbapenem-Resistant Escherichia coli Isolate with blaNDM-5 from a Dog in the United States

Microbiology Resource Announcements ◽

10.1128/mra.00872-19 ◽

2019 ◽

Vol 8 (34) ◽

Cited By ~ 3

Author(s):

Gregory H. Tyson ◽

Cong Li ◽

Olgica Ceric ◽

Renate Reimschuessel ◽

Stephen Cole ◽

...

Keyword(s):

United States ◽

Escherichia Coli ◽

Genome Sequence ◽

Complete Genome Sequence ◽

Complete Genome ◽

Carbapenem Resistance ◽

The United States ◽

Multidrug Resistant ◽

Content Type ◽

E Coli

The carbapenem resistance gene bla NDM-5 was identified in an Escherichia coli strain isolated from a dog. We report here the complete genome sequence of this E. coli strain; the bla NDM-5 gene was present on a large IncFII multidrug-resistant plasmid. This is the first bla NDM-5-carrying E. coli strain from an animal in the United States.

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Molecular Diversity and Plasmid Analysis of KPC-Producing Escherichia coli

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00452-16 ◽

2016 ◽

Vol 60 (7) ◽

pp. 4073-4081 ◽

Cited By ~ 19

Author(s):

Kalyan D. Chavda ◽

Liang Chen ◽

Michael R. Jacobs ◽

Robert A. Bonomo ◽

Barry N. Kreiswirth

Keyword(s):

United States ◽

Escherichia Coli ◽

Rapid Evolution ◽

The United States ◽

Content Type ◽

E Coli ◽

Carbapenem Resistant ◽

Plasmid Analysis ◽

Replication Gene ◽

Sequence Types

ABSTRACTThe emergence and spread ofKlebsiella pneumoniaecarbapenemase (KPC) amongEnterobacteriaceaepresents a major public health threat to the world. Although not as common as inK. pneumoniae, KPC is also found inEscherichia colistrains. Here, we genetically characterized 9 carbapenem-resistantE. colistrains isolated from six hospitals in the United States and completely sequenced theirblaKPC-harboring plasmids. The nine strains were isolated from different geographical locations and belonged to 8 differentE. colisequence types. SevenblaKPC-harboring plasmids belonged to four different known incompatibility groups (IncN, -FIA, -FIIK2, and -FIIK1) and ranged in size from ∼16 kb to ∼241 kb. In this analysis, we also identified two plasmids that have novel replicons: (i) pBK28610, which is similar to p34978-3 with an insertion of Tn4401b, and (ii) pBK31611, which does not have an apparent homologue in the GenBank database. Moreover, we report the emergence of a pKP048-like plasmid, pBK34397, inE. coliin the United States. Meanwhile, we also found examples of interspecies spread ofblaKPCplasmids, as pBK34592 is identical to pBK30683, isolated fromK. pneumoniae. In addition, we discovered examples of acquisition (pBK32602 acquired an ∼46-kb fragment including a novel replication gene, along with Tn4401band other resistance genes) and/or loss (pKpQIL-Ec has a 14.5-kb deletion compared to pKpQIL-10 and pBK33689) of DNA, demonstrating the plasticity of these plasmids and their rapid evolution in the clinic. Overall, our study shows that the spread ofblaKPC-producingE. coliis largely due to horizontal transfer ofblaKPC-harboring plasmids and related mobile elements into diverse genetic backgrounds.

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Colistin- and Carbapenem-Resistant Escherichia coli Harboring mcr-1 and bla NDM-5 , Causing a Complicated Urinary Tract Infection in a Patient from the United States: TABLE 1

mBio ◽

10.1128/mbio.01191-16 ◽

2016 ◽

Vol 7 (4) ◽

Cited By ~ 112

Author(s):

José R. Mediavilla ◽

Amee Patrawalla ◽

Liang Chen ◽

Kalyan D. Chavda ◽

Barun Mathema ◽

...

Keyword(s):

United States ◽

Escherichia Coli ◽

Urinary Tract ◽

The United States ◽

Clinical Samples ◽

Isolation And Identification ◽

Gram Negative ◽

E Coli ◽

Carbapenem Resistant ◽

Tract Infections

ABSTRACT Colistin is increasingly used as an antibiotic of last resort for the treatment of carbapenem-resistant Gram-negative infections. The plasmid-borne colistin resistance gene mcr-1 was initially identified in animal and clinical samples from China and subsequently reported worldwide, including in the United States. Of particular concern is the spread of mcr-1 into carbapenem-resistant bacteria, thereby creating strains that approach pan-resistance. While several reports of mcr-1 have involved carbapenem-resistant strains, no such isolates have been described in the United States. Here, we report the isolation and identification of an Escherichia coli strain harboring both mcr-1 and carbapenemase gene bla NDM-5 from a urine sample in a patient without recent travel outside the United States. The isolate exhibited resistance to both colistin and carbapenems, but was susceptible to amikacin, aztreonam, gentamicin, nitrofurantoin, tigecycline, and trimethoprim-sulfamethoxazole. The mcr-1 - and bla NDM-5 -harboring plasmids were completely sequenced and shown to be highly similar to plasmids previously reported from China. The strain in this report was first isolated in August 2014, highlighting an earlier presence of mcr-1 within the United States than previously recognized. IMPORTANCE Colistin has become the last line of defense for the treatment of infections caused by Gram-negative bacteria resistant to multiple classes of antibiotics, in particular carbapenem-resistant Enterobacteriaceae (CRE). Resistance to colistin, encoded by the plasmid-borne gene mcr-1 , was first identified in animal and clinical samples from China in November 2015 and has subsequently been reported from numerous other countries. In April 2016, mcr-1 was identified in a carbapenem-susceptible Escherichia coli strain from a clinical sample in the United States, followed by a second report from a carbapenem-susceptible E. coli strain originally isolated in May 2015. We report the isolation and identification of an E. coli strain harboring both colistin ( mcr-1 ) and carbapenem ( bla NDM-5 ) resistance genes, originally isolated in August 2014 from urine of a patient with recurrent urinary tract infections. To our knowledge, this is the first report in the United States of a clinical bacterial isolate with both colistin and carbapenem resistance, highlighting the importance of active surveillance efforts for colistin- and carbapenem-resistant organisms.

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Activity of Cefiderocol, Ceftazidime-Avibactam, and Eravacycline against Carbapenem-Resistant Escherichia coli Isolates from the United States and International Sites in Relation to Clonal Background, Resistance Genes, Coresistance, and Region

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00797-20 ◽

2020 ◽

Vol 64 (10) ◽

Cited By ~ 1

Author(s):

Brian D. Johnston ◽

Paul Thuras ◽

Stephen B. Porter ◽

Melissa Anacker ◽

Brittany VonBank ◽

...

Keyword(s):

Escherichia Coli ◽

Carbapenem Resistance ◽

The United States ◽

Asia Pacific ◽

Beta Lactamase ◽

Content Type ◽

Beta Lactamases ◽

E Coli ◽

Carbapenem Resistant ◽

Primary Agent

ABSTRACT Emerging carbapenem resistance in Escherichia coli, including sequence type 131 (ST131), the leading cause of extraintestinal E. coli infections globally, threatens therapeutic efficacy. Accordingly, we determined broth microdilution MICs for three distinctive newer agents, i.e., cefiderocol (CFDC), ceftazidime-avibactam (CZA), and eravacycline (ERV), plus 11 comparators, against 343 carbapenem-resistant (CR) clinical E. coli isolates, then compared susceptibility results with bacterial characteristics and region. The collection comprised 203 U.S. isolates (2002 to 2017) and 141 isolates from 17 countries in Europe, Latin America, and the Asia-West Pacific region (2003 to 2017). Isolates were characterized for phylogenetic group, resistance-associated sequence types (STs) and subsets thereof, and relevant beta-lactamase-encoding genes. CFDC, CZA, and ERV exhibited the highest percent susceptible (82% to 98%) after tigecycline (TGC) (99%); avibactam improved CZA's activity over that of CAZ (11% susceptible). Percent susceptible varied by phylogroup and ST for CFDC and CZA (greatest in phylogroups B2, D, and F, and in ST131, ST405, and ST648). Susceptibility also varied by resistance genotype, being higher with the Klebsiella pneumoniae carbapenemase (KPC) for CZA, lower with metallo-beta-lactamases for CFDC and CZA, and higher with the beta-lactamase CTX-M for ERV. Percent susceptible also varied by global region for CZA (lower in Asia-Pacific) and by U.S. region for ERV (lower in the South and Southeast). Although resistance to comparators often predicted reduced susceptibility to a primary agent (especially CFDC and CZA), even among comparator-resistant isolates the primary-agent-susceptible fraction usually exceeded 50%. These findings clarify the likely utility of CFDC, CZA, and ERV against CR E. coli in relation to multiple bacterial characteristics and geographical region.

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Molecular Epidemiology of CTX-M-Producing Escherichia coli Isolates at a Tertiary Medical Center in Western Pennsylvania

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00533-09 ◽

2009 ◽

Vol 53 (11) ◽

pp. 4733-4739 ◽

Cited By ~ 81

Author(s):

Hanna E. Sidjabat ◽

David L. Paterson ◽

Jennifer M. Adams-Haduch ◽

Lindsay Ewan ◽

Anthony W. Pasculle ◽

...

Keyword(s):

United States ◽

Escherichia Coli ◽

Gel Electrophoresis ◽

Medical Center ◽

The United States ◽

Pulsed Field Gel Electrophoresis ◽

Sequence Type ◽

The Other ◽

E Coli ◽

M 14

ABSTRACT A combination of phenotypic and genotypic methods was used to investigate 70 unique Escherichia coli clinical isolates identified as producing extended-spectrum β-lactamases (ESBLs) at a medical center in Pittsburgh, PA, between 2007 and 2008. Fifty-seven isolates (81%) produced CTX-M-type ESBLs, among which CTX-M-15 was predominant (n = 46). Isolates producing CTX-M-2, -9, -14, and -65 were also identified. One CTX-M-producing isolate coproduced CMY-2 cephalosporinase. Ten isolates (14%) produced SHV-type ESBLs, either SHV-5 or SHV-7. Two isolates produced only CMY-2 or -32. Pulsed-field gel electrophoresis revealed the presence of two major clusters of CTX-M-15-producing E. coli isolates, one in phylotype B2 (n = 15) and the other in phylotype A (n = 19). Of four phylotype B2 isolates that were able to transfer the bla CTX-M-15-carrying plasmids, three showed fingerprints related (>60%) to those of plasmids from phylotype A isolates. In phylotype B2, all CTX-M-15-producing isolates, as well as three isolates producing CTX-M-14, two producing SHV-5, and one producing SHV-7, belonged to the international epidemic clone defined by serotype O25:H4 and sequence type 131. The plasmids from eight of nine CTX-M-15-producing E. coli isolates of phylotype A that were examined were highly related to each other and were also found in two isolates belonging to phylotype D, suggesting horizontal transfer of this bla CTX-M-15-carrying plasmid between phylotypes. Our findings underscore the need to further investigate the epidemiology and virulence of CTX-M-producing E. coli in the United States.

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Epidemiologic and Microbiologic Characteristics of 28 Hospitalized Patients Cocolonized With Multiple Carbapenem-Resistant Enterobacteriaceae (CRE) in the United States

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.547 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s62-s62

Author(s):

Timileyin Adediran ◽

Anthony Harris ◽

J. Kristie Johnson ◽

David Calfee ◽

Loren Miller ◽

...

Keyword(s):

United States ◽

Secondary Analysis ◽

Positive Culture ◽

The United States ◽

Healthcare Personnel ◽

Surveillance Culture ◽

E Coli ◽

Carbapenem Resistant ◽

Multicenter Prospective Cohort Study ◽

Epidemiological Significance

Background: As carbapenem-resistant Enterobacteriaceae (CRE) prevalence increases in the United States, the risk of cocolonization with multiple CRE may also be increasing, with unknown clinical and epidemiological significance. In this study, we aimed to describe the epidemiologic and microbiologic characteristics of inpatients cocolonized with multiple CRE. Methods: We conducted a secondary analysis of a large, multicenter prospective cohort study evaluating risk factors for CRE transmission to healthcare personnel gown and gloves. Patients were identified between January 2016 and June 2019 from 4 states. Patients enrolled in the study had a clinical or surveillance culture positive for CRE within 7 days of enrollment. We collected and cultured samples from the following sites from each CRE-colonized patient: stool, perianal area, and skin. A modified carbapenem inactivation method (mCIM) was used to detect the presence or absence of carbapenemase(s). EDTA-modified CIM (eCIM) was used to differentiate between serine and metal-dependent carbapenemases. Results: Of the 313 CRE-colonized patients enrolled in the study, 28 (8.9%) were cocolonized with at least 2 different CRE. Additionally, 3 patients were cocolonized with >2 different CRE (1.0%). Of the 28 patients, 19 (67.6%) were enrolled with positive clinical cultures. Table 1 summarizes the demographic and clinical characteristics of these patients. The most frequently used antibiotic prior to positive culture was vancomycin (n = 33, 18.3%). Among the 62 isolates from 59 samples from 28 patients cocolonized patients, the most common CRE species were Klebsiella pneumoniae (n = 18, 29.0%), Escherichia coli (n = 10, 16.1%), and Enterobacter cloacae (n = 9, 14.5%). Of the 62 isolates, 38 (61.3%) were mCIM positive and 8 (12.9%) were eCIM positive. Of the 38 mCIM-positive isolates, 33 (86.8%) were KPC positive, 4 (10.5%) were NDM positive, and 1 (2.6%) was negative for both KPC and NDM. Also, 2 E. coli, 1 K. pneumoniae, and 1 E. cloacae were NDM-producing CRE. Conclusion: Cocolonization with multiple CRE occurs frequently in the acute-care setting. Characterizing patients with CRE cocolonization may be important to informing infection control practices and interventions to limit the spread of these organisms, but further study is needed.Funding: NoneDisclosures: None

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Comparison of the Reveal 20-Hour Method and the BAM Culture Method for the Detection of Escherichia coli O157:H7 in Selected Foods and Environmental Swabs: Collaborative Study

Journal of AOAC International ◽

10.1093/jaoac/84.3.737 ◽

2001 ◽

Vol 84 (3) ◽

pp. 737-751 ◽

Cited By ~ 5

Author(s):

Charles B Bird ◽

Rebecca J Hoerner ◽

Lawrence Restaino ◽

G Anderson ◽

W Birbari ◽

...

Keyword(s):

United States ◽

Escherichia Coli ◽

Collaborative Study ◽

Culture Method ◽

The United States ◽

Escherichia Coli O157 ◽

Private Industry ◽

E Coli ◽

Different Levels

Abstract Four different food types along with environmental swabs were analyzed by the Reveal for E. coli O157:H7 test (Reveal) and the Bacteriological Analytical Manual (BAM) culture method for the presence of Escherichia coli O157:H7. Twenty-seven laboratories representing academia and private industry in the United States and Canada participated. Sample types were inoculated with E. coli O157:H7 at 2 different levels. Of the 1095 samples and controls analyzed and confirmed, 459 were positive and 557 were negative by both methods. No statistical differences (p <0.05) were observed between the Reveal and BAM methods.

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Fecal Shedding of Escherichia coli O157:H7 in North Dakota Feedlot Cattle in the Fall and Spring

Journal of Food Protection ◽

10.4315/0362-028x-69.5.1154 ◽

2006 ◽

Vol 69 (5) ◽

pp. 1154-1158 ◽

Cited By ~ 13

Author(s):

MARGARET L. KHAITSA ◽

MARC L. BAUER ◽

GREGORY P. LARDY ◽

DAWN K. DOETKOTT ◽

REDEMPTA B. KEGODE ◽

...

Keyword(s):

United States ◽

Escherichia Coli ◽

North Dakota ◽

The United States ◽

Extreme Weather ◽

Early Spring ◽

Feedlot Cattle ◽

Escherichia Coli O157 ◽

Fecal Shedding ◽

E Coli

Cattle are an important reservoir of Escherichia coli O157:H7, which can lead to contamination of food and water, and subsequent human disease. E. coli O157:H7 shedding in cattle has been reported as seasonal, with more animals shedding during summer and early fall than during winter. North Dakota has relatively cold weather, especially in winter and early spring, compared with many other regions of the United States. The objective was to assess fecal shedding of E. coli O157: H7 in North Dakota feedlot cattle over the fall, winter, and early spring. One hundred forty-four steers were assigned randomly to 24 pens on arrival at the feedlot. Samples of rectal feces were obtained from each steer four times (October and November 2003, and March and April 2004) during finishing. On arrival (October 2003), 2 (1.4%) of 144 cattle were shedding E. coli O157:H7. The shedding increased significantly to 10 (6.9%) of 144 after 28 days (November 2003), to 76 (53%) of 143 at the third sampling (March 2004), and dropped significantly to 30 (21%) of 143 at the fourth (last) sampling (March 2004) before slaughter. Unfortunately, we were unable to sample the cattle during winter because of the extreme weather conditions. Sampling time significantly (P < 0.0001) influenced variability in E. coli O157:H7 shedding, whereas herd (P = 0.08) did not. The prevalence of E. coli O157:H7 shedding in North Dakota steers in fall and early spring was comparable to what has been reported in other parts of the United States with relatively warmer weather. Further research into E. coli O157:H7 shedding patterns during extreme weather such as North Dakota winters is warranted in order to fully assess the seasonal effect on the risk level of this organism.

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