Fecal carriage of extended spectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae after urinary tract infection – A three year prospective cohort study

Jørgensen, Silje Bakken; Søraas, Arne; Sundsfjord, Arnfinn; Liestøl, Knut; Leegaard, Truls Michael; Jenum, Pål A.

doi:10.1371/journal.pone.0173510

Cited by 43 publications

(39 citation statements)

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“…It was funded by South-Eastern Norway Regional Health Authority (grant number 2013060), and is registered in the ClinicalTrials.gov registration system, registration ID NCT01838213, 2013. The included human population has been part of three previously published studies [ 23 – 25 ], and some of the environmental samples have been mentioned in a short communication in press [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

A comparison of extended spectrum β-lactamase producing Escherichia coli from clinical, recreational water and wastewater samples associated in time and location

Jørgensen¹,

Søraas²,

Arnesen³

et al. 2017

PLoS ONE

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Extended spectrum β-lactamase producing Escherichia coli (ESBL-EC) are excreted via effluents and sewage into the environment where they can re-contaminate humans and animals. The aim of this observational study was to detect and quantify ESBL-EC in recreational water and wastewater, and perform a genetic and phenotypic comparative analysis of the environmental strains with geographically associated human urinary ESBL-EC. Recreational fresh-and saltwater samples from four different beaches and wastewater samples from a nearby sewage plant were filtered and cultured on differential and ESBL-selective media. After antimicrobial susceptibility testing and multi-locus variable number of tandem repeats assay (MLVA), selected ESBL-EC strains from recreational water were characterized by whole genome sequencing (WGS) and compared to wastewater and human urine isolates from people living in the same area. We detected ESBL-EC in recreational water samples on 8/20 occasions (40%), representing all sites. The ratio of ESBL-EC to total number of E. coli colony forming units varied from 0 to 3.8%. ESBL-EC were present in all wastewater samples in ratios of 0.56-0.75%. ST131 was most prevalent in urine and wastewater samples, while ST10 dominated in water samples. Eight STs and identical ESBL-EC MLVAtypes were detected in all compartments. Clinical ESBL-EC isolates were more likely to be multidrug-resistant (p<0.001).This study confirms that ESBL-EC, including those that are capable of causing human infection, are present in recreational waters where there is a potential for human exposure and subsequent gut colonisation and infection in bathers. Multidrug-resistant E. coli strains are present in urban aquatic environments even in countries where antibiotic consumption in both humans and animals is highly restricted.

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Section: Introductionmentioning

confidence: 99%

A comparison of extended spectrum β-lactamase producing Escherichia coli from clinical, recreational water and wastewater samples associated in time and location

Jørgensen¹,

Søraas²,

Arnesen³

et al. 2017

PLoS ONE

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“…The 158 antibiotic resistant isolates and 97 controls were differentiated into 126 unique MLVA types. A total of 65 (25%) of the isolates had MLVA types previously associated with O25b-ST131 (MT: 6, −2, −2, 14, 3, X, 5) [ 9 , 11 , 13 ] of which 7 (3%) were antibiotic susceptible controls. Of the gentamicin resistant isolates, 42/102 (41%) belonged to this cluster, as did 35/101 (35%) of the cephalosporin resistant isolates.…”

Section: Resultsmentioning

confidence: 99%

“…It has been reported as a rapid, accurate and cost-effective genotyping tool suitable as a “first-line-of-defense” method for epidemiological surveillance of multidrug-resistant E. coli [ 9 – 12 ]. In previous studies, E. coli O25b-ST131 has been shown to be associated with distinct MLVA types [ 9 , 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Genotypic characterization of gentamicin and cephalosporin resistant Escherichia coli isolates from blood cultures in a Norwegian university hospital 2011–2015

Fladberg

Jørgensen

Aamot

2017

Antimicrob Resist Infect Control

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BackgroundCephalosporin resistance in clinical E. coli isolates is increasing internationally. The increase has been caused by virulent and often multidrug-resistant clones, especially the extended spectrum β-lactamase (ESBL) producing E. coli clone O25b-ST131.MethodsIn Norway, recommended empirical treatment of sepsis consists of gentamicin and penicillin combined, or a broad-spectrum cephalosporin. To investigate if increased gentamicin and cephalosporins resistance rates in our hospital could be caused by specific clones, we conducted a retrospective study on E. coli blood culture isolates from 2011 through 2015. All E. coli isolates non-susceptible to gentamicin and/or third-generation cephalosporins were genotyped using multiple-locus variable-number of tandem repeat analysis (MLVA) and compared with antibiotic susceptible isolates. The frequency of the most common genes causing ESBL production (bla CTX-M, bla ampC) was examined by Real-Time PCR.ResultsA total of 158 cephalosporin and/or gentamicin resistant and 97 control isolates were differentiated into 126 unique MLVA types. Of these, 31% of the isolates belonged to a major MLVA cluster consisting of 41% of the gentamicin resistant and 35% of the cephalosporin resistant isolates. The majority (65/80 isolates) of this MLVA cluster contained MLVA types associated with the E. coli O25b-ST131 clone. Genes encoding CTX-M enzyme phylogroups 1 and 9 occurred in 65% and 19% of cephalosporin resistant isolates, respectively, whereas bla ampC-CIT was identified in 3%.ConclusionNo local E. coli bacteraemia clone was identified. Antibiotic resistance was dispersed over a variety of genotypes. However, association with the international E. coli O25b-ST131 clone was frequent and may be an important driver behind increased resistance rates. Monitoring and preventing dissemination of these resistant clones are important for continued optimal treatment.Electronic supplementary materialThe online version of this article (10.1186/s13756-017-0280-2) contains supplementary material, which is available to authorized users.

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“…Plasmids may also impair cell reproduction due to the energetic cost of their replication and maintenance, so conjugation and recombination could allow gene dosage optimisation and gene expression coordination. There is extensive evidence of AMR gene conjugation in the gut between species including E. coli [63][64][65][66], and also between its STs, such as: transfer of a blaCTX-M-1-positive Incl1 plasmid among ST1640, ST2144 and ST6331 in a single patient's gut [67]; a blaOXA-48 gene on a K. pneumoniae IncL/M-type plasmid from ST14 to ST666 [68] and from ST648 to ST866 [69]; a 113.6 kb IncF plasmid with a mercury detoxification operon blaKPC-2, blaOXA-9 and blaTEM-1A genes from ST69 to ST131 [70]; and transfer of a range of sulphonamide-(sul2) and ampicillin-resistance genes (blaTEM-1b) on a pNK29 plasmid within E. coli subtypes [71][72]. Moreover, the frequency of conjugation was ten times higher and more stable in blaCTX-M-15-producing ST131 than in K. pneumoniae [73].…”

Section: Introductionmentioning

confidence: 99%

Plasmids shape the diverse accessory resistomes ofEscherichia coliST131

Decano

Tran

Al-Foori

et al. 2020

Preprint

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19The human gut microbiome includes beneficial, commensal and pathogenic bacteria that possess 20 antimicrobial resistance (AMR) genes and exchange these predominantly through conjugative 21 plasmids. Escherichia coli is a significant component of the gastrointestinal microbiome and is 22typically non-pathogenic in this niche. In contrast, extra-intestinal pathogenic E. coli (ExPEC) 23including ST131 may occupy other environments like the urinary tract or bloodstream where they 24 express genes enabling AMR and host adhesion like type 1 fimbriae. The extent to which non-25pathogenic gut E. coli and infectious ST131 share AMR genes and key associated plasmids remains 26understudied at a genomic level. Here, we examined AMR gene sharing between gut E. coli and 27 ST131 to discover an extensive shared preterm infant resistome. In addition, individual ST131 show 28 extensive AMR gene diversity highlighting that analyses restricted to the core genome may be limiting 29and could miss AMR gene transfer patterns. We show that pEK499-like segments are ancestral to most 30 ST131 Clade C isolates, contrasting with a minority with substantial pEK204-like regions encoding a 31type IV fimbriae operon. Moreover, ST131 possess extensive diversity at genes encoding type 1, type 32 IV, P and F17-like fimbriae, particular within subclade C2. The type, structure and composition of 33 AMR genes, plasmids and fimbriae varies widely in ST131 and this may mediate pathogenicity and 34 infection outcomes. 35 36

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Fecal carriage of extended spectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae after urinary tract infection – A three year prospective cohort study

Cited by 43 publications

References 36 publications

A comparison of extended spectrum β-lactamase producing Escherichia coli from clinical, recreational water and wastewater samples associated in time and location

A comparison of extended spectrum β-lactamase producing Escherichia coli from clinical, recreational water and wastewater samples associated in time and location

Genotypic characterization of gentamicin and cephalosporin resistant Escherichia coli isolates from blood cultures in a Norwegian university hospital 2011–2015

Plasmids shape the diverse accessory resistomes ofEscherichia coliST131

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