Antimicrobial resistance profiles of diarrhoeagenic Escherichia coli isolated from travellers returning to the UK, 2015–2017

Abstract

Introduction. Diarrhoeagenic Escherichia coli (DEC) are difficult to distinguish from non-pathogenic commensal E. coli using traditional culture methods. The implementation of PCR targeting specific virulence genes characteristic of the five DEC pathotypes, has improved the detection of DEC in faecal specimens from patients with symptoms of gastrointestinal disease.Aim. Antimicrobial resistance (AMR) profiles of 660 strains of DEC isolated between 2015 and 2017 from UK travellers reporting symptoms of gastrointestinal disease were reviewed to look for evidence of emerging AMR associated with travellers' diarrhoea.Methodology. All isolates of DEC were sequenced, and sequence type, serotype, pathotype markers and AMR profiles were derived from the genome data. Results. A travel history was provided for 54.1 % (357/660) of cases, of which 77.0 % (275/357) reported travel outside the UK within 7 days of onset of symptoms, and 23.0 % (82/357) reported no travel in that time frame. Of the 660 strains of DEC in this study, 265 (40.2 %) samples were identified as EAEC, 48 (7.3 %) as EIEC, 61 (9.2 %) were ETEC and 286 (43.3 %) were EPEC. EPEC caused the highest percentage of infections in children (40.6 %) whilst the highest proportion of cases reporting recent travel were infected with ETEC (86.1 %). There were 390/660 (59.0 %) isolates resistant to at least one antimicrobial on the panel tested (EIEC, 81.3 %; ETEC, n=65.6 %; EAEC, n=73.2 %; EPEC, 40.9 %) and 265/660 (40.2 %) were multidrug-resistant (EIEC, 33.3 %; ETEC, 32.8 %; EAEC, 56.2 %; EPEC, 28.0 %). Genes conferring resistance to the beta-lactams and fluroquinolones were highest in the EAEC pathotype, 56.6 and 60.7%, respectively.Conclusions. Increasing MDR, along with resistance to the fluroquinolones and the third-generation cephalosporins, in DEC causing travellers' diarrhoea provides further evidence for the need to restrict the use of antimicrobial agents and continuous monitoring.

Genomic Epidemiology and Antimicrobial Susceptibility Profile of Enterotoxigenic Escherichia coli From Outpatients With Diarrhea in Shenzhen, China, 2015–2020

“…However, no CF was reported in Danish isolates whereas all Shenzhen isolates carried CS21. L4 lineage was also detected at low fraction (6%) in the global dataset (von Mentzer et al, 2014), and the subtyping combination of Shenzhen isolates, i.e., L4 (O25:H16, ST1491), was only identified in isolates from few travelers returning to the UK (Boxall et al, 2020) and from local diarrheal cases of China Pan et al, 2015;Li et al, 2017). Taken together, these results revealed that the major circulating ETEC lineages in Shenzhen, as well as in several other developed regions of China were distinctive, which are not the commonly detected global or endemic lineages.…”

Extended-spectrum beta-lactamase-producing strains among diarrhoeagenicEscherichia coli—prospective traveller study with literature review

“…In our literature search for studies of ESBL-DEC, we omitted those not reporting total number of DEC 43 , 45 or strain-specific travel data 46 , 47 ; these reports prove existence of ESBL-DEC, though. Instead, we selected, in accord with our initial aim, papers providing prevalence data on resistance among travel-acquired DEC or rates of ESBL-DEC among DEC originating in LMICs.…”

“…54 Likewise, substantial rates (53 and 57%) of ESBL-EAEC have been reported among clinical EAEC isolates in England; yet they do not report which of the strains were travel-acquired nor their countries origin. 46 , 47 …”

The aggregate-forming pili (AFP) mediates the aggregative adherence of a hybrid-pathogenic Escherichia coli (UPEC/EAEC) isolated from a urinary tract infection

“…Enteroaggregative E. coli (EAEC) represents an important pathotype that belongs to the IPEC group, which is responsible for cases of acute and persistent diarrheal illness in developing countries and cases of travelers´ diarrhea [ 4–7 ]. EAEC strains are identified by the production of the aggregative adherence (AA) on cultured epithelial cells, which is characterized by adhered bacteria on the surface of epithelial cells and the coverslip between cells in an arrangement resembling stacked bricks [ 8 , 9 ].…”