Within-Household Sharing of a Fluoroquinolone-Resistant Escherichia Coli Sequence Type St131 Strain Causing Pediatric Osteoarticular Infection

Johnson, James R.; Anderson, John T.; Clabots, Connie; Johnston, Brian; Cooperstock, Michael

doi:10.1097/inf.0b013e3181c89bd7

Cited by 43 publications

(36 citation statements)

References 13 publications

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“…Johnson et al provided novel evidence of the withinhousehold transmission of an ST131 strain between an infected patient (an 8-month-old girl with an osteoarticular infection) and another previously healthy member of the same family (the girl's mother). The same ST131 strain was detected in the digestive tracts of both patients (120), but it remains unclear in which direction the infection was transmitted. In this case, the ST131 strain was a fluoroquinolone-resistant strain that did not produce an ESBL.…”

Section: Pathogenic Characteristicsmentioning

confidence: 89%

“…In a study on the same animal model, involving comparison with the reference strain CFT073, Johnson et al (131) tested 61 E. coli isolates: (i) 44 clinical isolates classified into four sets of 11 isolates matched on the basis of their characteristics (ST131 and non-ST131 isolates resistant to fluoroquinolones and ST131 and non-ST131 isolates susceptible to fluoroquinolones), (ii) 12 urine and blood isolates corresponding to nine classical ExPEC clonal groups, and (iii) five fluoroquinolone-resistant E. coli ST131 isolates from case reports (distinctive clinical behavior or withinhousehold transmission) (120,122,123). They found a broad range of virulence potential within the study population.…”

Section: Pathogenic Characteristicsmentioning

confidence: 99%

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Escherichia coli ST131, an Intriguing Clonal Group

2014

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SUMMARY In 2008, a previously unknown Escherichia coli clonal group, sequence type 131 (ST131), was identified on three continents. Today, ST131 is the predominant E. coli lineage among extraintestinal pathogenic E. coli (ExPEC) isolates worldwide. Retrospective studies have suggested that it may originally have risen to prominence as early as 2003. Unlike other classical group B2 ExPEC isolates, ST131 isolates are commonly reported to produce extended-spectrum β-lactamases, such as CTX-M-15, and almost all are resistant to fluoroquinolones. Moreover, ST131 E. coli isolates are considered to be truly pathogenic, due to the spectrum of infections they cause in both community and hospital settings and the large number of virulence-associated genes they contain. ST131 isolates therefore seem to contradict the widely held view that high levels of antimicrobial resistance are necessarily associated with a fitness cost leading to a decrease in pathogenesis. Six years after the first description of E. coli ST131, this review outlines the principal traits of ST131 clonal group isolates, based on the growing body of published data, and highlights what is currently known and what we need to find out to provide public health authorities with better information to help combat ST131.

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Section: Pathogenic Characteristicsmentioning

confidence: 89%

Section: Pathogenic Characteristicsmentioning

confidence: 99%

Escherichia coli ST131, an Intriguing Clonal Group

2014

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“…Within-household sharing of E. coli strains, including members of sequence type ST131, among human and animal household members has been extensively documented (2,4,8). This process, which likely reflects host-to-host transmission, may contribute significantly to the community-wide dissemination of emerging antimicrobial-resistant uropathogenic E. coli lineages, such as clonal group A (trimethoprim-sulfamethoxazole resistance) (7,9), the O15:K52:H1 clonal group (fluoroquinolone resistance) (7), and perhaps of greatest concern, ST131 (fluoroquinolone and extended-spectrum cephalosporin resistance) (5,12,13).…”

Section: Case Reportmentioning

confidence: 99%

Community Transmission in the United States of a CTX-M-15-Producing Sequence Type ST131 Escherichia coli Strain Resulting in Death

et al. 2011

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A middle-aged woman developed fatal urosepsis due to a multidrug-resistant Escherichia coli strain representing sequence type ST131, a recently emerged, disseminated, multidrug-resistant extraintestinal pathogen, after presumably having acquired it from her extensively antibiotic-exposed sister with chronic recurrent cystitis. Susceptibility results (reported on day 4) showed resistance to the initially selected regimen. CASE REPORTThe index patient was a middle-aged female with chronic, recurrent symptomatic urinary tract infections (UTIs) due to Escherichia coli. Her urine isolates had become increasingly antimicrobial resistant over a 5-year period, including having become, for the past several years, extended-spectrum betalactamase (ESBL) positive.Both the index patient and a younger sister had alpha-1-antitrypsin deficiency. Whereas the index patient was only mildly affected, the younger sister was severely affected, leading to long-term care facility placement and a referral for lung transplantation (which was denied, because of continued smoking). The index patient had cared for the younger sister in the index patient's home for several months during the summer prior to the younger sister's acute illness.Shortly after the younger sister's temporary residence in the index patient's home, she began to experience mild dysuria when voiding (no indwelling or intermittent urinary catheter use) and low-grade fever. After a week of progressive symptoms, she was admitted to the hospital for presumed pyelonephritis.On admission, the patient appeared to be in mild distress with right-sided flank pain. Her temperature was 37.6°C, pulse was 52 beats per minute, blood pressure was 153/82 mm Hg, and respirations were 24 per minute. Oxyhemoglobin saturation was 92% on 4 liters of oxygen. The right flank was tender. Laboratory findings included leukocytosis (17,800 cells/l) with 88% neutrophils. Urinalysis showed marked pyuria and bacteriuria. Ciprofloxacin (400 mg intravenously every 12 h) and stress-dose corticosteroids were administered.Over 3 days, her clinical status worsened, and she was transferred to the intensive care unit for septic shock, presumed to be secondary to pyelonephritis. Her white blood cell (WBC) count rose to 18,400 cells/l (29% band forms), and her serum creatinine level increased to 2.7 mg/dl. The patient received mechanical ventilation and vasopressor therapy. Renal ultrasonography revealed moderate right hydronephrosis; a right percutaneous nephrostomy tube was placed. Blood and urine cultures grew E. coli.Due to the patient's precipitous decline, antimicrobial therapy was broadened empirically by adding piperacillin-tazobactam, based on local antibiogram data. On hospital day 4, septic shock worsened, requiring additional vasopressor support. Susceptibility data, which were now reported, showed the E. coli isolates to be resistant to fluoroquinolones and extended-spectrum cephalosporins but susceptible to piperacillin-tazobactam, amikacin, carbapenems, and trimethoprim-sulfamethoxazole. Therap...

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“…This, plus limited evidence of experimental virulence (5) and several case reports of unusually severe or fatal extraintestinal infections due to ST131 (8,11,40,48), has suggested that ST131's rapid and extensive emergence may be due in part to a high virulence potential, compared with other E. coli types.…”

mentioning

confidence: 99%

Virulence of Escherichia coli Clinical Isolates in a Murine Sepsis Model in Relation to Sequence Type ST131 Status, Fluoroquinolone Resistance, and Virulence Genotype

et al. 2012

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ABSTRACTEscherichia colisequence type ST131 (O25b:H4) has emerged over the past decade as a globally disseminated, multidrug-resistant pathogen. Unlike traditional antimicrobial-resistantE. coli, ST131 derives from virulence-associated phylogenetic group B2 and exhibits extraintestinal virulence factors. This, plus preliminary evidence of virulence in experimental animals, has suggested that ST131's epidemic emergence may be due to high virulence potential, compared with otherE. colitypes. To test this hypothesis, we compared a large number of matched ST131 and non-ST131E. coliclinical isolates, both fluoroquinolone resistant and susceptible, plus isolates from classic extraintestinal pathogenicE. coli(ExPEC) sequence types (STs) and case report ST131 household transmission isolates, for virulence in a mouse subcutaneous sepsis model. Overall, in mice, the study isolates produced a wide range of lethality and clinical illness. However, neither ST131 status nor fluoroquinolone phenotype correlated with this diversity of illness severity, which occurred within each of the 6 study groups. In contrast, multiple known or suspected ExPEC virulence genes, includingpap(P fimbriae),vat(vacuolating toxin),kpsMII (group 2 capsule),ibeA(invasion of brain endothelium), andclbB/N(colibactin synthesis), plus molecularly defined ExPEC status, were significantly associated with virulence. These findings point away from ST131 isolates as having higher virulence potential compared with otherE. colitypes in causing invasive extraintestinal infections and suggest instead that ST131's epidemiological success may reflect enhanced fitness for upstream steps in pathogenesis or in colonization and transmission. Additionally, the extensive within-ST virulence diversity suggests an opportunity to compare closely related strains to identify the responsible genetic determinants.

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Within-Household Sharing of a Fluoroquinolone-Resistant Escherichia Coli Sequence Type St131 Strain Causing Pediatric Osteoarticular Infection

Cited by 43 publications

References 13 publications

Escherichia coli ST131, an Intriguing Clonal Group

Escherichia coli ST131, an Intriguing Clonal Group

Community Transmission in the United States of a CTX-M-15-Producing Sequence Type ST131 Escherichia coli Strain Resulting in Death

Virulence of Escherichia coli Clinical Isolates in a Murine Sepsis Model in Relation to Sequence Type ST131 Status, Fluoroquinolone Resistance, and Virulence Genotype

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