Escherichia coli ST131 Producing Extended-Spectrum  -Lactamases Plus VIM-1 Carbapenemase: Further Narrowing of Treatment Options

Mantengoli, Elisabetta; Luzzaro, Francesco; Pecile, Patrizia; Cecconi, Daniela; Cavallo, Annalisa; Attala, Letizia; Bartoloni, Alessandro; Rossolini, Gian María

doi:10.1093/cid/ciq194

Cited by 26 publications

(17 citation statements)

References 5 publications

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“…Carbapenem-resistant Enterobacteriaceae, including those producing carbapenemases, have emerged in recent years. E. coli ST131 isolates harboring carbapenemases have already been reported (64,81,(98)(99)(100)(101)(102). This finding highlights the need to find new treatments for infections with E. coli ST131 isolates.…”

Section: Treatmentmentioning

confidence: 84%

“…The class A carbapenemase KPC-2 has been found in E. coli ST131 isolates from the United States (seven isolates), France (one isolate), Ireland (one isolate), and China, where they recently caused outbreaks (97)(98)(99)(100). Ambler class B enzymes from E. coli ST131 isolates have been reported in only a few studies: NDM-1 (two cases from India) (64,81), VIM-1 (one case in Italy) (101), and IMP-8 (one case in Taiwan) (102). Ambler class C enzymes have been detected more frequently than class B enzymes in ST131 isolates.…”

Section: Antibiotic Resistancementioning

confidence: 99%

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Escherichia coli ST131, an Intriguing Clonal Group

2014

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SUMMARY In 2008, a previously unknown Escherichia coli clonal group, sequence type 131 (ST131), was identified on three continents. Today, ST131 is the predominant E. coli lineage among extraintestinal pathogenic E. coli (ExPEC) isolates worldwide. Retrospective studies have suggested that it may originally have risen to prominence as early as 2003. Unlike other classical group B2 ExPEC isolates, ST131 isolates are commonly reported to produce extended-spectrum β-lactamases, such as CTX-M-15, and almost all are resistant to fluoroquinolones. Moreover, ST131 E. coli isolates are considered to be truly pathogenic, due to the spectrum of infections they cause in both community and hospital settings and the large number of virulence-associated genes they contain. ST131 isolates therefore seem to contradict the widely held view that high levels of antimicrobial resistance are necessarily associated with a fitness cost leading to a decrease in pathogenesis. Six years after the first description of E. coli ST131, this review outlines the principal traits of ST131 clonal group isolates, based on the growing body of published data, and highlights what is currently known and what we need to find out to provide public health authorities with better information to help combat ST131.

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Section: Treatmentmentioning

confidence: 84%

Section: Antibiotic Resistancementioning

confidence: 99%

Escherichia coli ST131, an Intriguing Clonal Group

2014

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“…However, our results raise some concern for relying on carbapenem as a treatment option in infections, especially for elderly individuals and/or those with comorbidities. Previous reports have suggested conflicting results (34,(39)(40)(41). Therefore, further studies are needed on this issue.…”

Section: Discussionmentioning

confidence: 94%

Molecular and Epidemiological Characterization of IMP-Type Metallo-β-Lactamase-Producing Enterobacter cloacae in a Large Tertiary Care Hospital in Japan

Hayakawa

Miyoshi‐Akiyama

Kirikae

et al. 2014

Antimicrob Agents Chemother

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d IMP-type metallo-␤-lactamase enzymes have been reported in different geographical areas and in various Gram-negative bacteria. However, the risk factors and epidemiology pertaining to IMP-type metallo-␤-lactamase-producing Enterobacter cloacae (IMP-producing E. cloacae) have not been systematically evaluated. We conducted a retrospective, matched case-control study of patients from whom IMP-producing E. cloacae isolates were obtained, in addition to performing thorough molecular analyses of the clinically obtained IMP-producing E. cloacae isolates. Unique cases with IMP-producing E. cloacae isolation were included. Patients with IMP-producing E. cloacae were matched to uninfected controls at a ratio of 1 to 3. Fifteen IMP-producing E. cloacae cases were identified, with five of the isolates being obtained from blood, and they were matched to 45 uninfected controls. All (100%) patients from whom IMP-producing E. cloacae isolates were obtained had indwelling devices at the time of isolation, compared with one (2.2%) uninfected control. Independent predictors for isolation of IMP-producing E. cloacae were identified as cephalosporin exposure and invasive procedures within 3 months. Although in-hospital mortality rates were similar between cases and controls (14.3% versus 13.3%), the in-hospital mortality of patients with IMP-producing E. cloacae-caused bacteremia was significantly higher (40%) than the rate in controls. IMP-producing E. cloacae isolates were frequently positive for other resistance determinants. The MICs of meropenem and imipenem were not elevated; 10 (67%) and 12 (80%) of the 15 IMP-producing E. cloacae isolates had a MIC of <1 g/ml. A phylogenetic tree showed a close relationship among the IMP-producing E. cloacae samples. Indwelling devices, exposure to cephalosporin, and a history of invasive procedures were associated with isolation of IMP-producing E. cloacae. Screening for carbapenemase production is important in order to apply appropriate clinical management and infection control measures.

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“…This clonal group has worldwide distribution as a common cause of UTI and BSI (3)(4)(5)(6)42). ST131 is remarkable for its carriage of a wide array of virulence factors (8,10,43,44) in addition to being a major producer of CTX-M-type ESBLs (1, 2, 7, 9, 10) and, more recently, for its acquisition of the carbapenemase-encoding genes bla KPC , bla VIM , and bla NDM-1 (45)(46)(47)(48). These drug resistance determinants are often located on plasmids and associated with integrons and IS elements (3,10,(49)(50)(51).…”

Section: Discussionmentioning

confidence: 99%

Clonal Composition and Community Clustering of Drug-Susceptible and -Resistant Escherichia coli Isolates from Bloodstream Infections

Adams‐Sapper

Diep

Perdreau-Remington

et al. 2013

Antimicrob Agents Chemother

107

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b Multidrug-resistant Escherichia coli strains belonging to a single lineage frequently account for a large proportion of extraintestinal E. coli infections in many parts of the world. However, limited information exists on the community prevalence and clonal composition of drug-susceptible E. coli strains. Between July 2007 and September 2010, we analyzed all consecutively collected Gram-negative bacterial isolates from patients with bloodstream infection (BSI) admitted to a public hospital in San Francisco for drug susceptibility and associated drug resistance genes. The E. coli isolates were genotyped for fimH single nucleotide polymorphisms (SNPs) and multilocus sequence types (MLSTs). Among 539 isolates, E. coli accounted for 249 (46%); 74 (30%) of them were susceptible to all tested drugs, and 129 (52%) were multidrug resistant (MDR). Only five MLST genotypes accounted for two-thirds of the E. coli isolates; the most common were ST131 (23%) and ST95 (18%). Forty-seven (92%) of 51 ST131 isolates, as opposed to only 8 (20%) of 40 ST95 isolates, were MDR (P < 0.0001). The Simpson's diversity index for drug-susceptible ST genotypes was 87%, while the index for MDR ST genotypes was 81%. ST95 strains were comprised of four fimH types, and one of these (f-6) accounted for 67% of the 21 susceptible isolates (P < 0.003). A large proportion (>70%) of both MDR and susceptible E. coli BSI isolates represented community-onset infections. These observations show that factors other than the selective pressures of antimicrobial agents used in hospitals contribute to community-onset extraintestinal infections caused by clonal groups of E. coli regardless of their drug resistance.

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Escherichia coli ST131 Producing Extended-Spectrum -Lactamases Plus VIM-1 Carbapenemase: Further Narrowing of Treatment Options

Cited by 26 publications

References 5 publications

Escherichia coli ST131, an Intriguing Clonal Group

Escherichia coli ST131, an Intriguing Clonal Group

Molecular and Epidemiological Characterization of IMP-Type Metallo-β-Lactamase-Producing Enterobacter cloacae in a Large Tertiary Care Hospital in Japan

Clonal Composition and Community Clustering of Drug-Susceptible and -Resistant Escherichia coli Isolates from Bloodstream Infections

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