Fluoroquinolone-resistant<i>Escherichia coli</i>, Indonesia

Kuntaman, Kuntaman; Lestari, Endang Sri; Severin, Juliëtte A.; Kershof, Irma M.; Mertaniasih, Ni Made; Purwanta, Marijam; Hadi, Usman; Johnson, James R.; Belkum, Alex van; Verbrugh, Henri A.

doi:10.3201/eid1109.041207

Cited by 25 publications

(22 citation statements)

References 22 publications

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“…However, a shift in the general characteristics of the E. coli population in the 2‐year period between the two studies cannot be entirely excluded. These findings are in accord with previous reports [7,13], as is the finding that the isolates are genetically heterogeneous [9]; however, in contrast to fluoroquinolone‐sensitive isolates [10], some evidence of clonal spread was revealed. It is interesting to note that the two largest clonal groups belonged to phylogroups B2 and D.…”

Section: Distribution Of Virulence Factors Among Fluoroquinolone‐ressupporting

confidence: 93%

“…FQREC isolates tend to be multiresistant, belong to less pathogenic phylogroups (A and B1), have fewer virulence factors [6,7], and are reported to be under‐represented in invasive infections [8]. Only limited clonality has been reported [9]. The aims of the present study were to characterise uropathogenic isolates of FQREC from Norway, and to examine the evidence of their clonal spread.…”

Section: Distribution Of Virulence Factors Among Fluoroquinolone‐resmentioning

confidence: 99%

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Fluoroquinolone-resistant uropathogenic Escherichia coli in Norway: evidence of clonal spread

Grude

Strand

Mykland

et al. 2008

Clinical Microbiology and Infection

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Prevalence, resistance profiles, virulence gene complements, and phylogenetic and clonal affinities of fluoroquinolone-resistant Escherichia coli from urinary tract infections (UTIs) in Norway were investigated. Of 7302 E. coli UTI isolates from 2003, 1.2% were fluoroquinolone-resistant; 35 of these fluoroquinolone-resistant isolates were included in the present study. The isolates were predominantly multiresistant, carried few virulence factors, and tended to belong to the less-virulent phylogroups A and B1. Although the isolates were genetically heterogeneous, there was evidence of a limited degree of clonal dissemination.

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Section: Distribution Of Virulence Factors Among Fluoroquinolone‐ressupporting

confidence: 93%

Section: Distribution Of Virulence Factors Among Fluoroquinolone‐resmentioning

confidence: 99%

Fluoroquinolone-resistant uropathogenic Escherichia coli in Norway: evidence of clonal spread

Grude

Strand

Mykland

et al. 2008

Clinical Microbiology and Infection

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“…From the original 3995 isolates, almost 400 were confirmed by Vitek 2 (bioMérieux, Marcy-l'Etoile, France). 11 Previously published validation of identification of E. coli by CHROMagar yielded a positive predictive value of 0.93, which is comparable to our results.…”

Section: Selection Of Strains and Susceptibility Testingsupporting

confidence: 82%

Determinants of carriage of resistant Escherichia coli in the Indonesian population inside and outside hospitals

Duerink

Lestari

Hadi

et al. 2007

Journal of Antimicrobial Chemotherapy

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Objectives: Antibiotic resistance is a worldwide healthcare problem exacerbated by antibiotic use and transmission of resistant bacteria. Not much is known about resistance in commensal flora and about determinants for resistance in Indonesia. This study analysed recent antibiotic use as well as demographic, socioeconomic, disease-related and healthcare-related determinants of rectal carriage of resistant Escherichia coli in the community and in hospitals in Indonesia.Methods: Carriers of susceptible E. coli were compared with carriers of E. coli with resistance to any of the tested antibiotics. Logistic regression analysis was performed to determine which variables were associated with carriage of resistant E. coli. Individuals in the community with varying levels of contact with healthcare institutions and hospitalized patients were analysed as separate populations. Results and conclusions:Of 3275 individuals (community 2494, hospital 781), 54% carried resistant E. coli. Recent antibiotic use was the most important determinant of resistance in both populations [community: odds ratio (OR) 1.8, 95% confidence interval (95% CI) 1.5 -2.3; hospital: OR 2.5, 95% CI 1.6 -3.9]. In the community, hospitalization (OR 2.4, 95% CI 2.0-3.0), diarrhoeal symptoms (OR 1.9, 95% CI 1.3-2.7) and age under 16 years (adults: OR 0.4, 95% CI 0.3 -0.5) were associated with carriage of resistant E. coli. For hospitalized patients, having no health insurance was associated with less resistance (OR 0.6, 95% CI 0.4 -0.9) and differences were observed between hospitals (Semarang: OR 2.2, 95% CI 1.5 -3.3) and departments (Paediatrics: OR 4.3, 95% CI 1.7 -10.7). Further research is needed to investigate whether transmission is responsible for these differences.

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“…With a carefully age-and sex-matched cohort of hospitalized UTI patients, we show, as previously reported, 12,13,15,19,25,27 that the B2 E. coli strains are less resistant to antibiotics than other phylogenetic E. coli groups and that this concerns quinolones in particular. Although the molecular mechanism is still unknown, these data indicate a role of the genomic background in the emergence of the resistance gained by point mutations, as also reported for extended b-lactamases, which are mobile elements that are horizontally transferred.…”

Section: Discussionsupporting

confidence: 55%

“…B2 group strains appear more sensitive to antibiotics than strains of the other phylogenetic groups, 10,20 especially to quinolones. 12,13,15,19,25,27 Likely, in the human community commensal environment strains from the B2 group would tend to carry fewer integrons than the others. 23 To gain a better understanding of the relationships between resistance, integrons, phylogenetic groups, and host environment, we selected three groups of human urinary tract infection (UTI) E. coli isolates that are known to comprise a high rate of B2 strains, 11 for the present study.…”

Section: Introductionmentioning

confidence: 98%

Integrons and Antibiotic Resistance in Phylogenetic Group B2Escherichia coli

Skurnik

Lacheeb

Bernède

et al. 2009

Microbial Drug Resistance

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It has been reported that Escherichia coli B2 phylogenetic group strains are more susceptible to antibiotics, especially to quinolones, and tend to carry less integrons than other phylogenetic groups in commensal environments. To gain a better understanding of the relationships between antibiotic resistance, integrons, and phylogenetic groups in an environment with high antibiotic selective pressure, we compared these characteristics in three selected groups of urinary tract infection E. coli isolated in a university hospital (G1, G2, and G3). The isolates were fully susceptible to antibiotics, resistant to amoxicillin and cotrimoxazol, or resistant to amoxicillin, cotrimoxazol, and nalidixic acid in the G1, G2, and G3 group, respectively. The prevalence of B2 isolates was significantly lower in the most resistant G3 group (22.6%) than in susceptible G1 (57.8%, p < 0.001) and G2 groups (50%, p < 0.01). In contrast, the prevalence of B2 isolates was not significantly different between G1 and G2 groups. The prevalence of integrons was nil in G1 isolates but very high in G2 (94.3%) and G3 (87.5%) isolates, and integrons were equally distributed among the phylogenetic groups. We propose a step-by-step mechanism for the emergence of antibiotic resistance in E. coli. Under very low selective pressure, resistance emerges without integrons. When the antibiotic pressure increases, quinolone and integron-mediated resistance occurs outside phylogenetic group B2. With strong antibiotic selective pressure, integrons are highly prevalent and widespread regardless of the phylogenetic group.

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Fluoroquinolone-resistantEscherichia coli, Indonesia

Abstract: High prevalence may be due to clonal spread and emergence of resistant strains.

Cited by 25 publications

References 22 publications

Fluoroquinolone-resistant uropathogenic Escherichia coli in Norway: evidence of clonal spread

Fluoroquinolone-resistant uropathogenic Escherichia coli in Norway: evidence of clonal spread

Determinants of carriage of resistant Escherichia coli in the Indonesian population inside and outside hospitals

Integrons and Antibiotic Resistance in Phylogenetic Group B2Escherichia coli

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