Multidrug-Resistant
            <i>Escherichia fergusonii</i>
            : a Case of Acute Cystitis

Savini, Vincenzo; Catavitello, Chiara; Talia, Marzia; Manna, Assunta; Pompetti, Franca; Favaro, Marco; Fontana, Carla; Febbo, Fabio; Balbinot, Andrea; Berardino, Fabio Di; Bonaventura, Giovanni Di; Zacomo, Silvia Di; Esattore, Francesca; D’Antonio, Domenico

doi:10.1128/jcm.01210-07

Cited by 54 publications

(52 citation statements)

References 10 publications

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“…Multidrug-resistant or extended-spectrum ␤-lactamase-producing E. fergusonii strains were found in patients with acute cystitis (5,6). The E. fergusonii isolate found in our patient was resistant to ampicillin alone.…”

Section: Case Reportmentioning

confidence: 76%

Escherichia fergusonii Bacteremia in a Diabetic Patient with Pancreatic Cancer

et al. 2011

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Although Escherichia fergusonii has been identified for decades, it has rarely been recovered from clinical specimens and its clinical significance remains unclear. We describe a case of E. fergusonii bacteremia in a diabetic patient with pancreatic cancer. The isolate was confirmed by three commercial identification systems and 16S rRNA gene sequence analysis. The patient's clinical condition gradually improved, and repeated blood cultures were negative after antibiotic treatment with an in vitro active agent (ceftriaxone). CASE REPORTA 73-year-old man who had a history of diabetes mellitus and pancreatic cancer presented with fever, vomiting, and abdominal discomfort for 1 day. On arrival at the emergency department, his body temperature was 38.6°C, and blood pressure was 98/51 mm Hg. Physical examination was unremarkable except for abdominal tenderness without rebounding pain. The laboratory findings were as follows: white blood cell count, 6,920/l with predominance of neutrophils (93%); Creactive protein level, 10.7 mg/dl (normal reference, Ͻ0.8 mg/ dl); lactic acid level, Ͼ12 mmol/liter (normal reference, 0.5 to 2.2 mmol/liter). Chest radiography did not show pneumonia patch, and urinalysis did not reveal pyuria. Computed tomography (CT) of the abdomen showed narrowing of celiac artery, superior mesenteric artery, and inferior mesenteric artery; dilatation of bowel; and edema of bowel wall. Under the impression of ischemic bowel diseases with severe sepsis, intravenous piperacillin-tazobactam (4.5 g every 8 h) was administered after collection of two sets of blood cultures. Four days later, two sets of blood cultures both grew Klebsiella pneumoniae and Escherichia fergusonii. These two isolates were susceptible to amoxicillin-clavulanic acid, piperacillin-tazobactam, cefuroxime, ceftriaxone, cefepime, imipenem, ciprofloxacin, gentamicin, and amikacin but resistant to ampicillin by the disk diffusion method. Antibiotic was shifted to ceftriaxone (1 g every 12 h) thereafter, the patient's fever gradually subsided, and repeat blood cultures 7 days after ceftriaxone use were negative. However, another episode of nosocomial infection with candidemia occurred on the 30th day after admission, and acute respiratory failure and shock developed then. Despite intravenous fluconazole being added for fungemia, the patient finally died on the 37th day after admission.The E. fergusonii isolate was identified by using three commercial identification systems: Enterotube II (Becton Dickinson Diagnostic Systems, Sparks, MD) (biocode 36640), PMIC/ ID-30 (Becton Dickinson Diagnostic Systems) (confidence value, 97%; sequence number 420070812594), and Vitek 2 system GN card (bioMérieux Inc., La Balme les Grottes, France) (probability of identity, 94%; bionumber 6605610160546211). The organism was positive for fermentation of amygdalin and cellobiose but negative for melibiose and sorbitol. This organism was further confirmed to the species level by partial 16S rRNA gene sequence analysis as previously described (7). The amplifica...

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Section: Case Reportmentioning

confidence: 76%

Escherichia fergusonii Bacteremia in a Diabetic Patient with Pancreatic Cancer

et al. 2011

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“…Among the members of Enterobacteriaceae, E. fergusonii has a distinct lactose-nonfermenting phenotype closest to that of E. coli. There are few reports of clinically significant E. fergusonii human and animal infections, suggesting that this organism may cause enteric infections in different hosts (1,8,16,21,23). Interestingly, we have encountered a high frequency of multidrug-resistant E. fergusonii in fecal samples of clinically sick pigs in our laboratory and at the National Veterinary Research and Quarantine Service (NVRQS) of South Korea since 2007.…”

mentioning

confidence: 86%

“…Despite the low percentage of ampicillin-resistant E. fergusonii isolates detected in this study compared to our previous study of E. coli, the presence of clinically important plasmid replicons carrying CTXM-15, toxins, and virulence factors, such as eae, STa, LT, F4, and F18, which have known roles in the pathogenesis of enteropathogenic (EPEC) and enterohemorrhagic (EHEC) E. coli, indicates that E. fergusonii could establish itself as a potential swine pathogen and emerging opportunistic zoonotic agent of public health importance (1,6,16). Furthermore, because E. fergusonii has already been found to cause disease suggestive of salmonellosis in animals with clinical manifestations including abortion, scour, and mastitis, more frequent isolation of E. fergusonii from clinical specimens of farm origin is expected as this pathogen is further characterized (1,8,16,21,23).…”

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confidence: 99%

Plasmid Typing and Resistance Profiling of Escherichia fergusonii and Other Enterobacteriaceae Isolates from South Korean Farm Animals

Rayamajhi

Bin

Shin

et al. 2011

Appl Environ Microbiol

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In this study, we focused on determining the distribution and prevalence of major plasmid replicons in ␤-lactam-resistant Escherichia fergusonii and Enterobacteriaceae of animal and human origin. A high degree of plasmid variability and multiple plasmid replicons were observed among the isolates. The IncF and IncI1 replicons were the most prevalent in E. fergusonii and Salmonella enterica serovar Indiana isolated from swine and poultry in South Korea, respectively. The presence of broad-host-range plasmid replicons such as IncN, IncA/C, IncHI1, and IncHI2 that are associated with important virulence genes and toxins as well as antimicrobial resistance determinants indicates that E. fergusonii has the potential to become an important pig pathogen and possible emerging opportunistic zoonotic pathogen.

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“…fergusonii was formerly known by the vernacular name enteric group 10 (EG 10) and received official standing as E. fergusonii in 1985 (5). The organism has been isolated from clinically relevant specimens including those from abdominal abscesses, symptomatic urinary tract infections, infusion-related sepsis, and a patient with diarrhea, as well as animal sources and human stool (5,11). One case of multidrug-resistant E. fergusonii causing cystitis is reported in the literature and had a similar pattern of antimicrobial resistance but was sensitive to expanded-spectrum cephalosporins and did not have an ESBL phenotype (11).…”

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confidence: 99%

First Description of an Extended-Spectrum-β-Lactamase-Producing Multidrug-Resistant Escherichia fergusonii Strain in a Patient with Cystitis

et al. 2010

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Extended-spectrum-␤-lactamase (ESBL)- CASE REPORTA 76-year-old Caucasian woman presented to the emergency department of a community hospital following a fall on ice. Investigations indicated she had sustained a fracture of her left hip and was admitted for a hip arthroplasty. A Foley catheter was inserted at the time of surgery and removed 48 h later. Three days after her surgery, the patient complained of urgency and dysuria. Urinalysis indicated the presence of moderate leukocyte esterase and microscopic pyuria. A culture was obtained, and an empirical 3-day treatment with trimethoprim-sulfamethoxazole was initiated for suspected catheter-associated cystitis.Quantitative urine culture plated to CHROMAgar Orientation (BD, Mississauga, ON, Canada) media revealed Ͼ10 8 CFU/liter of an organism producing Escherichia colilike pink colonies, which were subcultured for further identification because a brownish discoloration around the colonies suggested the possibility that the organism was not E. coli. Colonies were indole positive and oxidase negative. A Vitek 2 GN card (bioMérieux, Marcy L'étoile, France) was initially used for identification of the organism and provided a satisfactory (96.7%) identification of Escherichia fergusonii. Identification was confirmed using the API 20E strip (bioMérieux, Marcy L'étoile, France), which provided the code 5144113, corresponding to a 98.9% confident identification of E. fergusonii. The isolate was differentiated from E. coli by amygdalin, adonitol, and cellobiose fermentation and inability to ferment melibiose and sorbitol. Antimicrobial susceptibility, as determined by the Vitek 2 AST GN09 card (bioMérieux, Marcy L'étoile, France) and by broth microdilution using the CLSI-recommended method, is presented in Table 1. The organism was multidrug resistant, with demonstrated high-level resistance to cephalosporins, fluoroquinolones, sulfonamides, monobactams, and aminopenicillins. Although the Vitek 2 system did not suggest the possibility of ESBL production, the antimicrobial susceptibilities suggested the ESBL mechanism of resistance. This was investigated using the CLSI disk diffusion method using ceftriaxone and ceftazidime disks with and without clavulanate (AB Biodisk, Solna, Sweden) (4). Clavulanate increased the inhibition zone diameter by 9 mm for ceftriaxone and 15 mm for ceftazidime. Although the clavulanate synergy method is not CLSI approved for this organism, PCR and sequencing of SHV, CTX-M, and TEM ␤-lactamase genes as described by Mulvey et al. (8) revealed the presence of TEM-1 and SHV-12, the later conferring the ESBL phenotype (2).Despite in vitro resistance to sulfonamides, the patient's symptoms temporarily improved but recurred a week later. A second culture revealed the same organism. Because intravenous therapy was not indicated, a regimen of amoxicillin-clavulanate, 500 mg three times a day (TID), was given for 7 days. The treatment resulted in resolution of symptoms and microscopic pyuria. Subsequent urine samples a week and a month after treatment...

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Multidrug-Resistant Escherichia fergusonii : a Case of Acute Cystitis

Cited by 54 publications

References 10 publications

Escherichia fergusonii Bacteremia in a Diabetic Patient with Pancreatic Cancer

Escherichia fergusonii Bacteremia in a Diabetic Patient with Pancreatic Cancer

Plasmid Typing and Resistance Profiling of Escherichia fergusonii and Other Enterobacteriaceae Isolates from South Korean Farm Animals

First Description of an Extended-Spectrum-β-Lactamase-Producing Multidrug-Resistant Escherichia fergusonii Strain in a Patient with Cystitis

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