Escherichia coli O25b-ST131: a pandemic, multiresistant, community-associated strain

Abstract

Escherichia coli sequence type 131 (ST131) is a worldwide pandemic clone, causing predominantly community-onset antimicrobial-resistant infection. Its pandemic spread was identified in 2008 by utilizing multilocus sequence typing (MLST) of CTX-M-15 extended-spectrum β-lactamase-producing E. coli from three continents. Subsequent research has confirmed the worldwide prevalence of ST131 harbouring a broad range of virulence and resistance genes on a transferable plasmid. A high prevalence of the clone (∼30%-60%) has been identified amongst fluoroquinolone-resistant E. coli. In addition, it potentially harbours a variety of β-lactamase genes; most often, these include CTX-M family β-lactamases, and, less frequently, TEM, SHV and CMY β-lactamases. Our knowledge of ST131's geographical distribution is incomplete. A broad distribution has been demonstrated amongst antimicrobial-resistant E. coli from human infection in Europe (particularly the UK), North America, Canada, Japan and Korea. High rates are suggested from limited data in Asia, the Middle East and Africa. The clone has also been detected in companion animals, non-companion animals and foods. The clinical spectrum of disease described is similar to that for other E. coli, with urinary tract infection predominant. This can range from cystitis to life-threatening sepsis. Infection occurs in humans of all ages. Therapy must be tailored to the antimicrobial resistance phenotype of the infecting isolate and the site of infection. Phenotypic detection of the ST131 clone is not possible and DNA-based techniques, including MLST and PCR, are described.

Incidence of Antibiotic-Resistant Escherichia coli Bacteriuria According to Age and Location of Onset: A Population-Based Study From Olmsted County, Minnesota

“…This increase in resistance among E coli in the community has been reported in numerous studies 3,4,[39][40][41] and may be due to several factors, including increasing reliance on outpatient medical management, increasing antimicrobial use in the outpatient setting, transmission of drug-resistant strains from the hospital into the community, or expansion of drug-resistant clones within the community. 3,14,18,42 Because resistance to fluoroquinolone and fluoroquinolone plus trimethoprim-sulfamethoxazole increased more markedly than resistance to other antibiotics among our E coli isolates from 2005 through 2009, we hypothesize that there has been expansion of drug-resistant clones within Olmsted County. In the United States, more than half of E coli with resistance to fluoroquinolones or fluoroquinolones plus trimethoprim-sulfamethoxazole are sequence type 131, 1 a highly drug-resistant and globally disseminated clonal group first reported in 2008.…”

“…In the United States, more than half of E coli with resistance to fluoroquinolones or fluoroquinolones plus trimethoprim-sulfamethoxazole are sequence type 131, 1 a highly drug-resistant and globally disseminated clonal group first reported in 2008. 2,3,5,17 We are currently performing molecular epidemiology studies to determine whether clonal expansion of sequence type 131 or other clonal groups has contributed to the rapid increase in drug resistance we observed.…”

Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: A retrospective population-based analysis

“…20,21 The global spread of the E. coli sequence type (ST131) with multiple antimicrobial resistance genes and the horizontal transfer gene are of great concern in the development of resistance to prophylactic antibiotics. 22 Patient-specific risk factors for FQ resistance include increasing age, comorbidities, international travel, recent hospitalization, prior FQ exposure and urinary catheterization. 1,3,23,24 The aim of our study was to characterize the prescribing patterns of prophylactic antibiotics prior to TRUS-PB in a large urban centre.…”

Surveillance of antibiotic resistance

“…Subsequent analysis using MLST showed that strains A-E all belonged to an extremely successful clone of E. coli of ST131 which is now known to have disseminated globally [62,63]. It is also of note that E. coli ST131 is commonly resistant to quinolones and was a likely contributor to the increase in ciprofloxacin resistance seen in E. coli during the 2000s [63]. Hence the increase in resistance to ciprofloxacin and third-generation cephalosporins in E. coli during this time is probably explained in large part by clonal expansion following the emergence of ST131 in the UK.…”