Impact of Inadequate Empiric Antimicrobial Therapy on Clinical Outcomes of Patients With Escherichia coli or Klebsiella Species Bacteremia

This study was conducted to evaluate the effect of inadequate empiric antimicrobial therapy (IEAT) on mortality of patients with Escherichia coli or Klebsiella species bacteremia. Patients with E coli or Klebsiella species bacteremia were retrospectively analyzed to determine the effect of IEAT on 14-day mortality. IEAT of bacteremia was defined as administration of an antimicrobial agent to which the microorganism responsible for the bacteremia was resistant. IEAT was significantly associated with central venous catheter placement, Klebsiella species, and antimicrobial resistance among the 135 patients with E coli or Klebsiella species bacteremia (110 adequate, 25 inadequate). IEAT significantly increased 14-day mortality (32% vs 19%; P = .019). The increased 14-day mortality associated with IEAT was consistent among patients infected with E coli (33% vs 11%) or Klebsiella species (31% vs 15%). Independent risk factors for 14-day mortality in the multivariate analysis included Acute Physiology and Chronic Health Evaluation II (APACHE II) score (odds ratio [OR] 1.16; 95% confidence interval [CI] = 1.07-1.27), IEAT (OR 9.4; 95% CI = 1.36-65.14), and initial imipenem therapy (OR 20.66; 95% CI = 1.48-287.74). Of the 6 patients receiving empiric imipenem/cilastatin, 3 had APACHE II scores ≥ 30 (all 3 of these patients died). The 14-day mortality rate was similar for patients who received IEAT, regardless of whether their therapy was changed (32%) or not (33%). Based on these results and previous studies, greater efforts should be made to identify patients at risk for resistant pathogens before initiating antimicrobial therapy.

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Patients With Perforated Peptic Ulcers: Risk Factors for Morbidity and Mortality

International Surgery ◽

10.9738/intsurg-d-15-00180.1 ◽

2019 ◽

Vol 103 (11-12) ◽

pp. 578-584

Author(s):

Fatih Ciftci ◽

Fazilet Erözgen

Keyword(s):

Risk Factors ◽

Peptic Ulcer ◽

Postoperative Period ◽

Perforated Peptic Ulcer ◽

Apache Ii ◽

Morbidity And Mortality ◽

Apache Ii Score ◽

Peptic Ulcers ◽

Presentation Time ◽

Independent Risk Factors

Perforated peptic ulcers continue to be an important problem in surgical practice. In this study, risk factors for peptic ulcer perforation-associated mortality and morbidity were evaluated. This is a retrospective study of patients surgically treated for perforated peptic ulcer over a decade (March 1999–December 2014). Patient age, sex, complaints at presentation, time lapse between onset of complaints and presentation to the hospital, physical findings, comorbidities, laboratory and imaging findings, length of hospitalization, morbidity, and mortality were recorded. The Mannheim peritonitis index (MPI) and Acute Physiology and Chronic Health Evaluation (APACHE) II score were calculated and recorded for each patient on admission to the hospital. Of the 149 patients, mean age was 50.6 ± 19 years (range: 17–86). Of these, 129 (86.5%) were males and 20 (13.4%) females. At least 1 comorbidity was found in 42 (28.1%) of the patients. Complications developed in 36 (24.1%) of the patients during the postoperative period. The most frequent complication was wound site infection. There was mortality in 26 (17.4%) patients and the most frequent cause of mortality was sepsis. Variables that were found to have statistically significant effects on morbidity included age older than 60 years, presence of comorbidities, and MPI (P = 0.029, 0.013, and 0.013, respectively). In a multivariate analysis, age older than 60 years, presence of comorbidities, and MPI were independent risk factors that affected morbidity. In the multivariate logistic regression analysis, age older than 60 years [P = 0.006, odds ratio (OR) = 5.99, confidence interval (CI) = 0.95] and comorbidities (OR = 2.73, CI = 0.95) were independent risk factors that affected morbidity. MPI and APACHE II scoring were both predictive of mortality. Age older than 60, presentation time, and MPI were independent risk factors for mortality. Undelayed diagnosis and appropriate treatment are of the utmost importance when presenting with a perforated peptic ulcer. We believe close observation of high-risk patients during the postoperative period may decrease morbidity and mortality rates.

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Antimicrobial Resistance Patterns and ESBL of Uropathogens Isolated from Adult Females in Najran Region of Saudi Arabia

Clinics and Practice ◽

10.3390/clinpract11030080 ◽

2021 ◽

Vol 11 (3) ◽

pp. 650-658

Author(s):

Mohammed Yahia Alasmary

Keyword(s):

Escherichia Coli ◽

Saudi Arabia ◽

Antimicrobial Resistance ◽

Klebsiella Pneumoniae ◽

Urine Samples ◽

Klebsiella Species ◽

E Coli ◽

Government Hospitals ◽

Resistance Patterns ◽

Tract Infections

Background: To explore the prevalence of urinary tract infections (UTIs) among female patients in the Najran region of Saudi Arabia and determine their antimicrobial resistance pattern. Methods: This study was conducted on 136 urine samples collected from outpatient departments (OPDs) of the different government hospitals in the Najran region of Saudi Arabia. Over one year, the results of susceptibility testing reports of outpatient midstream urine samples from three government hospitals were prospectively evaluated. Results: Of 136 urine samples, only 123 (90.45%) were found to show significant growth for UTIs, from which 23 different uropathogens were identified. Escherichia coli (58.5%) was the most commonly isolated organism, followed by Klebsiella pneumoniae (8.1%). The isolated microorganism showed increased resistance patterns from 3.3% to 62.6%, with an overall resistance of 27.19%. Meropenem was the most effective antimicrobial, followed by amikacin and ertapenem (0.47%, 0.91%, and 1.5% resistance, respectively). At the same time, ampicillin and cephazolin were the least (62.6% and 59.5% resistance, respectively) effective. Overall, eleven (8.94%) uropathogens isolates were ESBLs, among which there were eight (6.5%) Escherichia coli, one (0.81%) Klebsiella pneumoniae, one (0.81%) Klebsiella oxytoca, and one (0.81%) Citrobacter amalonaticus. Conclusions: E. coli remains the most commonly isolated causative uropathogens, followed by Klebsiella species. The prevalence of pathogenic E. coli and Klebsiella species underscores the importance of developing cost-effective, precise, and rapid identification systems to minimize public exposure to uropathogens. Antibiotic susceptibility data revealed that most of the isolates were resistant to the majority of the antibiotics. The patients with UTIs in the Najran region of Saudi Arabia are at a high risk of antibiotic resistance, leading to significant problems in outpatient department (OPD) treatment outcomes and raising the alarm for the physician to change their empiric treatment.

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Early prediction of extubation failure in patients with severe pneumonia: a retrospective cohort study

Bioscience Reports ◽

10.1042/bsr20192435 ◽

2020 ◽

Vol 40 (2) ◽

Author(s):

He Yu ◽

Jian Luo ◽

Yuenan Ni ◽

Yuehong Hu ◽

Dan Liu ◽

...

Keyword(s):

Blood Glucose ◽

Medical Records ◽

Severe Pneumonia ◽

Extubation Failure ◽

Apache Ii ◽

Apache Ii Score ◽

Common Causes ◽

Independent Risk Factors ◽

Logistic Regressions ◽

Rbc Transfusion

Abstract Backgroud: Severe pneumonia is one of the most common causes for mechanical ventilation. We aimed to early identify severe pneumonia patients with high risk of extubation failure in order to improve prognosis. Methods: From April 2014 to December 2015, medical records of intubated patients with severe pneumonia in intensive care unit were retrieved from database. Patients were divided into extubation success and failure groups, and multivariate logistic regressions were performed to identify independent predictors for extubation failure. Results: A total of 125 eligible patients were included, of which 82 and 43 patients had extubation success and failure, respectively. APACHE II score (odds ratio (OR) 1.141, 95% confident interval (CI) 1.022–1.273, P = 0.019, cutoff at 17.5), blood glucose (OR 1.122, 95%CI 1.008–1.249, P = 0.035, cutoff at 9.87 mmol/l), dose of fentanyl (OR 3.010, 95%CI 1.100–8.237, P = 0.032, cutoff at 1.135 mg/d), and the need for red blood cell (RBC) transfusion (OR 2.774, 95%CI 1.062–7.252, P = 0.037) were independent risk factors for extubation failure. Conclusion: In patients with severe pneumonia, APACHE II score > 17.5, blood glucose > 9.87 mmol/l, fentanyl usage > 1.135 mg/d, and the need for RBC transfusion might be associated with higher risk of extubation failure.

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Statewide surveillance of carbapenemase-producing carbapenem-resistant Escherichia coli and Klebsiella species in Washington state, October 2012–December 2017

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.26 ◽

2020 ◽

Vol 41 (6) ◽

pp. 716-722

Author(s):

Mimi R. Precit ◽

Kelly Kauber ◽

William A. Glover ◽

Scott J. Weissman ◽

Tashina Robinson ◽

...

Keyword(s):

Public Health ◽

Escherichia Coli ◽

Health Care ◽

The United States ◽

Case Definition ◽

Washington State ◽

Public Health Department ◽

Klebsiella Species ◽

E Coli ◽

Carbapenem Resistant

AbstractBackground:Carbapenem-resistant Enterobacterales (CRE) are common causes of healthcare-associated infections and are often multidrug resistant with limited therapeutic options. Additionally, CRE can spread within and between healthcare facilities, amplifying potential harms.Objective:To better understand the burden, risk factors, and source of acquisition of carbapenemase genes in clinical Escherichia coli and Klebsiella spp isolates from patients in Washington to guide prevention efforts.Design:Multicenter prospective surveillance study.Methods:Escherichia coli and Klebsiella spp isolates meeting the Washington state CRE surveillance case definition were solicited from clinical laboratories and tested at Washington Public Health Laboratories using polymerase chain reaction (PCR) for the 5 most common carbapenemase genes: blaKPC, blaNDM, blaIMP, blaVIM, and blaOXA-48. Case patients positive by PCR were investigated by the public health department.Results:From October 2012 through December 2017, 363 carbapenem-resistant E. coli and Klebsiella spp isolates were tested. Overall, 45 of 115 carbapenem-resistant K. pneumoniae (39%), 1 of 8 K. oxytoca (12.5%), and 28 of 239 carbapenem-resistant E. coli (11.7%) were carbapenemase positive. Of 74 carbapenemase-positive isolates, blaKPC was most common (47%), followed by blaNDM (30%), blaOXA-48 (22%), and blaIMP (1%). Although all cases had healthcare exposure, blaKPC acquisition was associated with US health care, whereas non-blaKPC acquisition was associated with international health care or travel.Conclusions:We report that blaKPC, the most prevalent carbapenemase in the United States, accounts for nearly half of carbapenemase cases in Washington state and that most KPC-cases are likely acquired through in-state health care.

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Bloodstream Infections Due to Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae: Risk Factors for Mortality and Treatment Outcome, with Special Emphasis on Antimicrobial Therapy

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.48.12.4574-4581.2004 ◽

2004 ◽

Vol 48 (12) ◽

pp. 4574-4581 ◽

Cited By ~ 180

Author(s):

Cheol-In Kang ◽

Sung-Han Kim ◽

Wan Beom Park ◽

Ki-Deok Lee ◽

Hong-Bin Kim ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Treatment Outcome ◽

Klebsiella Pneumoniae ◽

Antimicrobial Therapy ◽

Bloodstream Infections ◽

Extended Spectrum Beta Lactamase ◽

E Coli ◽

Extended Spectrum ◽

Empirical Antimicrobial Therapy

ABSTRACT This study was conducted to evaluate risk factors for mortality and treatment outcome of bloodstream infections due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK). ESBL production in stored K. pneumoniae and E. coli blood isolates from Jan 1998 to Dec 2002 was phenotypically determined according to NCCLS guidelines and/or the double-disk synergy test. A total of 133 patients with ESBL-EK bacteremia, including 66 patients with ESBL-producing K. pneumoniae and 67 with ESBL-producing E. coli, were enrolled. The overall 30-day mortality rate was 25.6% (34 of 133). Independent risk factors for mortality were severe sepsis, peritonitis, neutropenia, increasing Acute Physiology and Chronic Health Evaluation II score, and administration of broad-spectrum cephalosporin as definitive antimicrobial therapy (P < 0.05 for each of these risk factors). In 117 of the 133 patients, excluding 16 patients who died within 3 days after blood culture sample acquisition, the 30-day mortality rates according to definitive antibiotics were as follows: carbapenem, 12.9% (8 of 62); ciprofloxacin, 10.3% (3 of 29); and others, such as cephalosporin or an aminoglycoside, 26.9% (7 of 26). When patients who received appropriate definitive antibiotics, such as carbapenem or ciprofloxacin, were evaluated, mortality in patients receiving inappropriate empirical antimicrobial therapy was found not to be significantly higher than mortality in those receiving appropriate empirical antimicrobial therapy (18.9 versus 15.5%; P = 0.666). Carbapenem and ciprofloxacin were the most effective antibiotics in antimicrobial therapy for ESBL-EK bacteremia. A delay in appropriate definitive antimicrobial therapy was not associated with higher mortality if antimicrobial therapy was adjusted appropriately according to the susceptibility results. Our data suggest that more prudent use of carbapenem as empirical antibiotic may be reasonable.

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Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase- Producing Escherichia coli: Risk Factors for Inadequate Initial Antimicrobial Therapy

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00063-08 ◽

2008 ◽

Vol 52 (9) ◽

pp. 3244-3252 ◽

Cited By ~ 72

Author(s):

Mario Tumbarello ◽

Michela Sali ◽

Enrico Maria Trecarichi ◽

Fiammetta Leone ◽

Marianna Rossi ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Antimicrobial Therapy ◽

Bloodstream Infections ◽

Disease Epidemiology ◽

E Coli ◽

Infectious Disease Epidemiology ◽

Extended Spectrum ◽

Initial Antimicrobial Therapy

ABSTRACT Extended-spectrum-β-lactamase (ESBL)-producing strains of Escherichia coli are a significant cause of bloodstream infections (BSI) in hospitalized and nonhospitalized patients. We previously showed that delaying effective antimicrobial therapy in BSI caused by ESBL producers significantly increases mortality. The aim of this retrospective 7-year analysis was to identify risk factors for inadequate initial antimicrobial therapy (IIAT) (i.e., empirical treatment based on a drug to which the isolate had displayed in vitro resistance) for inpatients with BSI caused by ESBL-producing E. coli. Of the 129 patients considered, 56 (43.4%) received IIAT for 48 to 120 h (mean, 72 h). Independent risk factors for IIAT include an unknown BSI source (odds ratios [OR], 4.86; 95% confidence interval [CI], 1.98 to 11.91; P = 0.001), isolate coresistance to ≥3 antimicrobials (OR, 3.73; 95% CI, 1.58 to 8.83; P = 0.003), hospitalization during the 12 months preceding BSI onset (OR, 3.33; 95% CI, 1.42 to 7.79; P = 0.005), and antimicrobial therapy during the 3 months preceding BSI onset (OR, 2.65; 95% CI, 1.11 to 6.29; P = 0.02). IIAT was the strongest risk factor for 21-day mortality and significantly increased the length of hospitalization after BSI onset. Our results underscore the need for a systematic approach to the management of patients with serious infections by ESBL-producing E. coli. Such an approach should be based on sound, updated knowledge of local infectious-disease epidemiology, detailed analysis of the patient's history with emphasis on recent contact with the health care system, and aggressive attempts to identify the infectious focus that has given rise to the BSI.

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Antimicrobial Susceptibility Profile of Urinary Tract Pathogenic Infections in Diabetic Patients Attending a Health Facility in Kumasi, Ghana

International Journal of Pathogen Research ◽

10.9734/ijpr/2020/v4i230109 ◽

2020 ◽

pp. 37-45

Author(s):

Maxwell Adu-Poku ◽

Matthew Glover Addo

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Health Facility ◽

Antimicrobial Susceptibility ◽

Diabetic Patients ◽

Klebsiella Species ◽

E Coli ◽

Antimicrobial Susceptibility Profile ◽

Pseudomonas Species ◽

Proteus Species

Aims: This study seeks to investigate the antimicrobial susceptibility profile of urinary tract pathogenic infections in diabetic patients attending a health facility in Kumasi, Ghana. Study Design: A total of 285 patients were recruited using Cochran’s formula at a prevalence of 26.4% for this study from patients attending the University Hospital from April 2018 to October 2018. Data were collected using a structured questionnaire. Methodology: Clean-catch midstream urine samples were screened for the presence of pathogenic bacteria and their antimicrobial susceptibility pattern using recommended culture methods. Results: Out of the 285 patients, 125 (43.9%) were diabetic with 90 (72%) being female and 35 (28%) male. There was no association between UTI’s and gender (P=0.5799) with diabetic patients recording higher bacteriuria compared to non-diabetics (P< 0.001). Isolates from 113 (39.4%) of the samples were identified and these included, Escherichia coli, Pseudomonas species, Klebsiella species, Proteus species and Staphylococcus aureus. The most predominant was E. coli 62 (54.9%) followed by S. aureus 24 (21.2%), Klebsiella species 14(12.4%), Pseudomonas species 12(10.6%) and Proteus species 1(0.9%). E. coli showed a high antimicrobial sensitivity rates against most of the tested antibiotics, gentamycin (90.3%), amikacin (98.4%), nalidixic (34%), cefotaxime (80.6%) and nitrofurantoin (93%). Proteus spp. on the other hand, showed a 100% sensitivity to all the antibiotics except tetracycline, amikacin and cefotaxime. It was observed that Escherichia coli was mostly resistant to tetracycline (96.8%), norfloxacin (69.4%) and cefotaxime (61.4%). Conclusion: S. aureus showed a higher level of resistance to tetracycline (100%). The prevalence of this study indicated that UTI among diabetic patients was relatively comparable with other studies. Amikacin and nitrofurantoin should be recommended as antimicrobials for the treatment of UTIs whilst the use of tetracycline, norfloxacin and cefotaxime should be discouraged.

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Epidemiology of paediatric gastrointestinal colonisation by extended spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae isolates in north-west Cambodia

10.1101/173294 ◽

2017 ◽

Cited By ~ 1

Author(s):

JJ van Aartsen ◽

CE Moore ◽

CM Parry ◽

P Turner ◽

N Phot ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Klebsiella Pneumoniae ◽

Resistance Genes ◽

Genetic Relatedness ◽

De Novo ◽

Intestinal Parasites ◽

E Coli ◽

Extended Spectrum ◽

Independent Risk Factors

ABSTRACTExtended-spectrum cephalosporin resistance (ESC-R) in Escherichia coli and Klebsiella pneumoniae is a healthcare threat; high gastrointestinal carriage rates are reported from South-east Asia. Colonisation prevalence data in Cambodia are lacking. We determined gastrointestinal colonisation prevalence of ESC-resistant E. coli (ESC-R-EC) and K. pneumoniae (ESC-R-KP) in Cambodian children/adolescents and associated risk factors; characterised relevant resistance genes, their genetic contexts, and the genetic relatedness of ESC-R strains using whole genome sequencing (WGS). Faeces and questionnaire data were obtained from individuals <16 years in northwestern Cambodia, 2012. WGS of cultured ESC-R-EC/KP was performed (Illumina). Maximum likelihood phylogenies were used to characterise relatedness of isolates; ESC-R-associated resistance genes and their genetic contexts were identified from de novo assemblies using BLASTn and automated/manual annotation. 82/148 (55%) of children/adolescents were ESC-R-EC/KP colonised; 12/148 (8%) were co-colonised with both species. Independent risk factors for colonisation were hospitalisation (OR: 3.12, 95%, CI [1.52-6.38]) and intestinal parasites (OR: 3.11 [1.29-7.51]); school attendance conferred decreased risk (OR: 0.44 [0.21-0.92]. ESC-R strains were diverse; the commonest ESC-R mechanisms were blaCTX-M 1 and 9 sub-family variants. Structures flanking these genes were highly variable, and for blaCTX-M-15,-55and-27, frequently involved IS26. Chromosomal blaCTX-M integration was common in E. coli. Gastrointestinal ESC-R-EC/KP colonisation is widespread in Cambodian children/adolescents; hospital admission and intestinal parasites are independent risk factors. The genetic contexts of blaCTX-M are highly mosaic, consistent with rapid horizontal exchange. Chromosomal integration of blaCTX-M may result in stable propagation in these community-associated pathogens.

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A retrospective study of sepsis-associated encephalopathy: epidemiology, clinical features and adverse outcomes

BMC Emergency Medicine ◽

10.1186/s12873-020-00374-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jiayi Chen ◽

Xiaobei Shi ◽

Mengyuan Diao ◽

Guangyong Jin ◽

Ying Zhu ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Clinical Features ◽

Sofa Score ◽

Adverse Outcomes ◽

Apache Ii ◽

Apache Ii Score ◽

Gastrointestinal Infections ◽

Independent Risk Factors ◽

Poor Outcomes

Abstract Background Sepsis-associated encephalopathy (SAE) is a common complication of sepsis that may result in worse outcomes. This study was designed to determine the epidemiology, clinical features, and risk factors of SAE. Methods This was a retrospective study of all patients with sepsis who were admitted to the Critical Care Medicine Department of Hangzhou First People’s Hospital Affiliated with Zhejiang University School of Medicine from January 2015 to December 2019. Results A total of 291 sepsis patients were screened, and 127 (43.6%) were diagnosed with SAE. There were significant differences in median age, proportion of underlying diseases such as hypertension, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, gastrointestinal infections, detection rate of Enterococcus, and 28-day mortality between the SAE and non-SAE groups. Both the SOFA score and APACHE II score were independent risk factors for SAE in patients with sepsis. All 127 SAE patients were divided into survival and non-survival groups. The age, SOFA score, and APACHE II score were independently associated with 28-day mortality in SAE patients. Conclusion In the present retrospective study, nearly half of patients with sepsis developed SAE, which was closely related to poor outcomes. Both the SOFA score and APACHE II score were independent risk factors for predicting the occurrence and adverse outcome of SAE.

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Antimicrobial Resistance Profiles of Adherent Invasive Escherichia coli Show Increased Resistance to β-Lactams

Antibiotics ◽

10.3390/antibiotics9050251 ◽

2020 ◽

Vol 9 (5) ◽

pp. 251 ◽

Cited By ~ 1

Author(s):

Margarita Martinez-Medina ◽

Francesco Strozzi ◽

Belén Ruiz Del Castillo ◽

Natalia Serrano-Morillas ◽

Nuria Ferrer Bustins ◽

...

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Genome Sequencing ◽

Antimicrobial Therapy ◽

De Novo ◽

Genomic Analysis ◽

The Other ◽

Phenotypic Resistance ◽

E Coli ◽

Gut Mucosa

The adherent invasive Escherichia coli (AIEC) pathotype has been associated with the aetiology of Crohn’s disease (CD). Scarce reports have shown the antimicrobial resistance (AMR) profiles of AIEC. Despite antibiotics not being recommended to treat CD, antimicrobial therapy could be useful in stratified patients, such as AIEC carriers. We examined the antimicrobial resistance profiles of AIEC strains to identify which therapies could be effective or confer a risk for such patients. Phenotypic resistance to 30 antimicrobials was tested according to CLSI standards. AIEC (n = 22) and non-pathogenic E. coli (non-AIEC) strains (n = 37) isolated from the gut mucosa of 31 CD patients and 18 controls were studied. De novo genome sequencing was carried out for 39 of the 59 strains, and AMR genes were searched using the DeepARG database in these genomes and 33 additional AIEC publicly available genomes. The strains isolated from CD and controls showed similar phenotypic AMR profiles. The genomic analysis did not reveal an increased prevalence of AMR genes. However, AIEC strains were more frequently resistant to β-lactams than non-AIEC strains (11 AIEC (50%) and 5 non-AIEC (22%) strains were resistant to at least one β-lactam; p < 0.042). Two AIEC strains were resistant to expanded-spectrum cephalosporins. One strain carried a plasmid-mediated AmpC β-lactamase (CMY-69), and the other presented mutations in the promotor of the intrinsic chromosomal AmpC related to the hyperproduction of this enzyme. The rest of the strains were resistant to β-lactams not including expanded-spectrum cephalosporins. The majority carried TEM-related β-lactamases. Genomic analysis including external AIEC revealed that the gene sul1 encoding for sulphonamide resistance was more frequent in AIEC strains than non-AIEC strains (34.6% vs. 9.5%, p = 0.030). AMR in AIEC is a matter of concern regarding the putative implication of the pathotype in CD. The high proportion of AIEC resistant to β-lactams warrants caution about the risk there may be in the use of these antimicrobials in AIEC-colonized CD patients.

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