Predictors of Antimicrobial‐Resistant<i>Escherichia coli</i>in the Feces of Vegetarians and Newly Hospitalized Adults in Minnesota and Wisconsin

Sannes, Mark R.; Belongia, Edward A.; Kieke, Burney A.; Smith, Kirk E.; Kieke, Amy; Vandermause, Mary; Bender, Jeffrey B.; Clabots, Connie; Winokur, Patricia L.; Johnson, James R.

doi:10.1086/525530

Cited by 27 publications

(26 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nonetheless, the previous study supports the concept that travel, and especially foreign travel, increases the risk of having a TMP-SMX-resistant uropathogen. A similar conclusion was reached in a recent study of the predictors of fecal colonization with antimicrobial agent-resistant E. coli among newly hospitalized adults and healthy vegetarians in Minnesota and Wisconsin, in which foreign travel (particular to the developing world) was the strongest independent risk factor associated with TMP-SMZ resistance (22).…”

Section: Discussionsupporting

confidence: 81%

Risk Factors for Trimethoprim-Sulfamethoxazole Resistance in Patients with Acute Uncomplicated Cystitis

Colgan

Johnson

Kuskowski

et al. 2008

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Emerging antimicrobial resistance among uropathogens makes the management of acute uncomplicated cystitis increasingly challenging. Few prospective data are available on the risk factors for resistance to trimethoprim-sulfamethoxazole (TMP-SMX), the drug of choice in most settings. In order to evaluate this, we prospectively enrolled women 18 to 50 years of age presenting to an urban primary care practice with symptoms of cystitis. Potentially eligible women provided a urine sample for culture and completed a questionnaire regarding putative risk factors for TMP-SMX resistance. Escherichia coli isolates were tested for clonal group A (CGA) membership by a fumC-specific PCR. Of 165 women with cystitis symptoms, 103 had a positive urine culture and were eligible for participation. E. coli was the predominant uropathogen (86%). Fifteen (14.6%) women had a TMP-SMX-resistant (TMP-SMX r ) organism (all of which were E. coli). Urinary tract infection (UTI) is one of the most common indications for antimicrobial therapy. Recent studies have demonstrated that fluoroquinolones are increasingly being used instead of trimethoprim-sulfamethoxazole (TMP-SMX) to treat UTIs in ambulatory women, the majority of whom likely have acute uncomplicated cystitis (9, 14, 25). Concurrently, and perhaps consequently, fluoroquinolone resistance among uropathogens is increasing in prevalence (5, 10). Clearly, strategies that can be used to decrease the rate of fluoroquinolone use, particularly for uncomplicated cystitis, are needed.One such strategy is to facilitate the appropriate prescription of TMP-SMX as the preferred agent for the treatment of UTIs in women. The use of TMP-SMX for uncomplicated cystitis is declining (14). The reasons for this are not entirely clear, but a contributing factor may be concerns over the rising rates of TMP-SMX resistance among uropathogens (23). Guidelines for the treatment of acute uncomplicated cystitis recommend the use of alternative agents in settings where TMP-SMX is problematic due to anticipated resistance, intolerance, or other factors (8,26). Unfortunately, local susceptibility data often come from hospital-based microbiology laboratories and may not accurately reflect the prevalence of TMP-SMX resistance among otherwise healthy outpatient women with UTIs, many of whom do not have urine cultures and susceptibilities performed (7). Thus, the actual prevalence of resistance in any given locale is usually unknown or may be overestimated on the basis of hospital-derived data, leading to the unnecessary avoidance of TMP-SMX as a first-line agent.Knowledge of the individual host factors that predict TMP-SMX resistance would allow clinicians to make an informed prescribing decision on a case-by-case basis, eliminating the need to know population-specific resistance rates. Although several studies have attempted to elucidate such individual risk factors, most of those studies have been limited by being retrospective or including mixed gender and age groups that do not fulfill the traditional criteria fo...

show abstract

Section: Discussionsupporting

confidence: 81%

Risk Factors for Trimethoprim-Sulfamethoxazole Resistance in Patients with Acute Uncomplicated Cystitis

Colgan

Johnson

Kuskowski

et al. 2008

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…(11), quinolone-resistant Shigella spp. (21), trimethoprim-sulfamethoxazole-resistant E. coli (6,32), SHV-12-producing Salmonella enterica serovar Typhi (1), CTX-M-15-producing Shigella sonnei (14), and CTX-M-15-producing E. coli (9).…”

Section: Resultsmentioning

confidence: 99%

Molecular Characteristics of Travel-Related Extended-Spectrum-β-Lactamase-Producing Escherichia coli Isolates from the Calgary Health Region

Pitout

Campbell

Church

et al. 2009

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Extended-spectrum-␤-lactamase (ESBL)-producing Escherichia coli has recently emerged as a major risk factor for community-acquired, travel-related infections in the Calgary Health Region. Molecular characterization was done on isolates associated with infections in returning travelers using isoelectric focusing, PCR, and sequencing for bla CTX-M s, bla TEM s, bla SHV s , bla OXA s, and plasmid-mediated quinolone resistance determinants. Genetic relatedness was determined with pulsed-field gel electrophoresis using XbaI and multilocus sequence typing (MLST). A total of 105 residents were identified; 6/105 (6%) presented with hospital-acquired infections, 9/105 (9%) with health care-associated community-onset infections, and 90/105 (86%) with community-acquired infections. Seventy-seven of 105 (73%) of the ESBL-producing E. coli isolates were positive for bla CTX-M genes; 55 (58%) produced CTX-M-15, 13 (14%) CTX-M-14, six (6%) CTX-M-24, one (1%) CTX-M-2, one (1%) CTX-M-3, and one (1%) CTX-M-27, while 10 (10%) produced TEM-52, three (3%) TEM-26, 11 (11%) SHV-2, and four (4%) produced SHV-12. Thirty-one (30%) of the ESBL-producing E. coli isolates were positive for aac(6)-Ib-cr, and one (1%) was positive for qnrS. The majority of the ESBL-producing isolates (n ‫؍‬ 95 [90%]) were recovered from urine samples, and 83 (87%) were resistant to ciprofloxacin. The isolation of CTX-M-15 producers belonging to clone ST131 was associated with travel to the Indian subcontinent (India, Pakistan), Africa, the Middle East, and Europe, while clonally unrelated strains of CTX-M-14 and -24 were associated with travel to Asia. Our study suggested that clone ST131 coproducing CTX-M-15, OXA-1, TEM-1, and AAC(6)-Ib-cr and clonally unrelated CTX-M-14 producers have emerged as important causes of community-acquired, travel-related infections.

show abstract

“…Sequence identity between antibiotic resistance genes amenable to horizontal transfer in clinical pathogens and in environmental bacteria indicate that the former recruit these genes from the latter (20,37,38). Food consumption represents only one exposure route of humans to environmental antibiotic resistance and also for the interaction of humans with the natural resistome (39,40). The relative risks of environmental, community-acquired, and nosocomial exposure are largely unknown and ideally would be considered in a human health risk assessment framework (41).…”

Section: Discussionmentioning

confidence: 99%

Impact of Manure Fertilization on the Abundance of Antibiotic-Resistant Bacteria and Frequency of Detection of Antibiotic Resistance Genes in Soil and on Vegetables at Harvest

Marti

Scott

Tien

et al. 2013

Appl Environ Microbiol

402

236

View full text Add to dashboard Cite

bConsumption of vegetables represents a route of direct human exposure to bacteria found in soil. The present study evaluated the complement of bacteria resistant to various antibiotics on vegetables often eaten raw (tomato, cucumber, pepper, carrot, radish, lettuce) and how this might vary with growth in soil fertilized inorganically or with dairy or swine manure. Vegetables were sown into field plots immediately following fertilization and harvested when of marketable quality. Vegetable and soil samples were evaluated for viable antibiotic-resistant bacteria by plate count on Chromocult medium supplemented with antibiotics at clinical breakpoint concentrations. DNA was extracted from soil and vegetables and evaluated by PCR for the presence of 46 gene targets associated with plasmid incompatibility groups, integrons, or antibiotic resistance genes. Soil receiving manure was enriched in antibiotic-resistant bacteria and various antibiotic resistance determinants. There was no coherent corresponding increase in the abundance of antibiotic-resistant bacteria enumerated from any vegetable grown in manure-fertilized soil. Numerous antibiotic resistance determinants were detected in DNA extracted from vegetables grown in unmanured soil. A smaller number of determinants were additionally detected on vegetables grown only in manured and not in unmanured soil. Overall, consumption of raw vegetables represents a route of human exposure to antibiotic-resistant bacteria and resistance determinants naturally present in soil. However, the detection of some determinants on vegetables grown only in freshly manured soil reinforces the advisability of pretreating manure through composting or other stabilization processes or mandating offset times between manuring and harvesting vegetables for human consumption.

show abstract

Predictors of Antimicrobial‐ResistantEscherichia coliin the Feces of Vegetarians and Newly Hospitalized Adults in Minnesota and Wisconsin

Cited by 27 publications

References 15 publications

Risk Factors for Trimethoprim-Sulfamethoxazole Resistance in Patients with Acute Uncomplicated Cystitis

Risk Factors for Trimethoprim-Sulfamethoxazole Resistance in Patients with Acute Uncomplicated Cystitis

Molecular Characteristics of Travel-Related Extended-Spectrum-β-Lactamase-Producing Escherichia coli Isolates from the Calgary Health Region

Impact of Manure Fertilization on the Abundance of Antibiotic-Resistant Bacteria and Frequency of Detection of Antibiotic Resistance Genes in Soil and on Vegetables at Harvest

Contact Info

Product

Resources

About