Meningitis Caused by Escherichia coli Producing TEM-52 Extended-Spectrum β-Lactamase within an Extensive Outbreak in a Neonatal Ward: Epidemiological Investigation and Characterization of the Strain

Abstract

Outbreaks caused by Enterobacteriaceae isolates producing extended-spectrum ␤-lactamases (ESBL) in neonatal wards can be difficult to control. We report here an extensive outbreak in a neonatal ward with a case of meningitis caused by an ESBL-producing Escherichia coli strain. Between 24 March and 29 April 2009, among the 59 neonates present in the ward, 26 neonates with ESBL-producing E. coli rectal colonization were detected (44%). One of the colonized neonates developed meningitis with a favorable outcome after treatment combining imipenem, gentamicin, and ciprofloxacin. Despite strict intensification of hygiene and isolation procedures for more than 1 month, ward closure to new admissions was necessary to control the outbreak. Randomly amplified polymorphic DNA and pulsed-field gel electrophoresis analysis performed on 31 isolates recovered from 26 neonates and two mother's milk samples showed a clonal strain. ESBL PCR assays indicated that the strain harbored a TEM-52 ESBL encoded by an IncI1 replicon. Phylogenetic analysis by multilocus sequence typing showed that the strain belonged to rare phylogenetic group C, which is closely related to group B1 but appears as group A by the triplex PCR phylogrouping method. The strain harbored the virulence genes fuyA, aer, and iroN and was virulent in a mouse model of septicemia. This work indicates the high potential of colonization, transmission, and virulence of some ESBL-producing E. coli clones.With Streptococcus agalactiae, Escherichia coli is one of the two most common bacterial species frequently responsible of neonatal infections (34). E. coli is the second leading cause of neonatal bacterial meningitis in industrial countries, and recent studies suggest that extraintestinal pathogenic E. coli isolates belong mainly to phylogenetic group B2 (2, 6). An increased rate of E. coli ampicillin resistance after the initiation of intrapartum antimicrobial prophylaxis was previously reported (5, 34). However, most of the E. coli isolates remained susceptible to extended-spectrum cephalosporins (ESC), but currently, extended-spectrum ␤-lactamases (ESBL) are becoming an increasingly important cause of resistance to ESC in E. coli, frequently involving the CTX-M-type enzymes (29). In 2008, Boyer-Mariotte et al. reported one case of fatal neonatal meningitis caused by a CTX-M-15-producing E. coli strain (7). Emergence of ESBL-producing Enterobacteriaceae is a major problem, since the choice of drugs for antimicrobial treatment is limited; moreover, such strains have been increasingly implicated in nosocomial outbreaks in neonatal intensive care units (11,23,33,35). While the spread of CTX-M-type ESBL in the family Enterobacteriaceae, especially in E. coli, has been described worldwide (11,13,15,17), the spread of TEM-type ESBL has been less frequently reported (8, 9). We report here a case of neonatal meningitis caused by a TEM-52 ESBL-producing E. coli strain within a serious outbreak among neonates with rectal colonization and the characteristics of the strain. MATERIA...

Inhibitor-Resistant TEM- and OXA-1-Producing Escherichia coli Isolates Resistant to Amoxicillin-Clavulanate Are More Clonal and Possess Lower Virulence Gene Content than Susceptible Clinical Isolates

“…Most of the virulence-associated traits of isolates belonging to ST88 were adhesins, protectins, and siderophores that may facilitate persistence and survival in adverse circumstances. Phylogroup C has previously been identified in a virulent strain causing an outbreak in a neonatal ward (37). Interestingly, in this study, 30% of E. coli isolates belonged to phylogroup C, mainly due to the reclassification of prevalent clonal complexes ST10 and ST23 (Table 2) previously classified as phylogroup A by the former method of Clermont et al (19).…”

Antibiotic susceptibility profiles of neonatal invasive isolates of Escherichia coli from a 2-year nationwide surveillance study in Germany, 2009–2010

“…The emergence of ESBL-producing strains needs to be closely monitored in the future, considering its potential impact on the choice of empirical therapy. Outbreaks of ESBL-producing E. coli strains on neonatal intensive care units did not occur during the study period, but have recently been reported from elsewhere in Europe [8,9].…”

Phylo-typing of clinicalEscherichia coliisolates originating from bovine mastitis and canine pyometra and urinary tract infection by means of quadruplex PCR

“…Nevertheless, the increase in genome research and multi-locus sequence data put forward eight new phylo-groups of E. coli, assigned as A, B1, B2, C, D, E and F which belong to E. coli sensu stricto and one correspond to the Escherichia cryptic clade I (Jaureguy et al 2008;Moissenet et al 2010;Tenaillon et al 2010;Clermont et al 2011;Luo et al 2011). Group E is recognized as a new group that was formerly comprised unassigned strains; group F designated as sister group of B2; group C includes strains closely related but distinct from group B1 and an Escherichia clade I which is considered to be a new phylo-group that is phenotypically indistinguishable but genotypically different from E. coli (Clermont et al 2013).…”