The recent increase of CTX-M-15-producing Escherichia coli isolates in our institution was caused by diverse clonal backgrounds, including mainly B2 sequence type 131 (ST131) clones presenting variable virulence profiles but also A 1 (ST617, ST410), B1, and D 1 (ST405) clones. Besides IncFII-pC15-1a, we detected multidrug-resistant IncA/C 2 and IncN plasmids carrying bla CTX-M-15 and/or qnrS1. Our study highlights the diversification of highly transmissible resistant and virulent clones and the recombinogenic potential of broad-host plasmids contributing to the expansion of genetic regions coding for multidrug resistance to other bacterial lineages.
The current pandemic spread of bla CTX-M-15 has been greatly facilitated by high-risk clones of Escherichia coli (mainly B2 sequence type 131 [ST131]) and Klebsiella pneumoniae (6,22) and by IncFII plasmids with high potential for recombination (6,17). The recent identification of bla in other enterobacterial species (especially Salmonella spp. or Enterobacter spp. in developing countries) and different conjugative plasmids highlights the risk of further spread of this gene to other successful genetic backgrounds (4,10,14,17,19,21). Differences in pulsed-field gel electrophoresis (PFGE) and virulence profiles among widespread fluoroquinolone-resistant B2 ST131 clones carrying bla CTX-M-15 from different locations indicate frequent local processes of diversification of this lineage, with some of these variants being widely disseminated (5, 13).In Spain, CTX-M-15 is among the most frequent extendedspectrum -lactamase (ESBL) variants identified in ESBL-producing E. coli and increased 8-fold between 2000 and 2006 (from 0.5% to 4.04%) in hospitalized patients (5, 9). In our hospital, the bla CTX-M-15 gene was detected for the first time in 2002 as associated with a diversity of K. pneumoniae and phylogroup D E. coli clonal backgrounds and IncFII plasmids (15). The aim of this study was to analyze the influence of different genetic elements on the recent expansion of bla CTX-M-15 in our institution.Thirty-three nonreplicate CTX-M-15-producing E. coli isolates representing 33.7% of the total ESBL-producing E. coli isolates at Ramón y Cajal University Hospital in Madrid in 2008 were studied. This rate is higher than that observed in recent regional (26% in Barcelona) and national (15%) surveys in our country (5, 9). They were recovered mostly from outpatients (19/33; 57%) but also from patients located at medical (9/33; 27%), intensive care unit (ICU) (4/33; 12%), and surgical (1/33; 3%) wards, and they were mostly obtained from urine samples (26/33; 78.8%).Clonal analysis performed by characterization of E. coli phylogenetic groups, PFGE, and multilocus sequence typing (6) (http: //mlst.ucc.ie/mlst/dbs/Ecoli) established that CTX-M-15 producers belonged to a diversity of phylogroups, with B2 3 being the most predominant (22/33; 66.7%; 21 ST131 and 1 ST372). The presence of 38 virulence factors (VFs) associated with extraintestinal pathogenic E. coli (ExPEC) was screened b...