Whole genome analysis of cephalosporin-resistant Escherichia coli from bloodstream infections in Australia, New Zealand and Singapore: high prevalence of CMY-2 producers and ST131 carrying blaCTX-M-15 and blaCTX-M-27

To characterize MDR Escherichia coli from bloodstream infections (BSIs) in Australia, New Zealand and Singapore. We collected third-generation cephalosporin-resistant (3GC-R) E. coli from blood cultures in patients enrolled in a randomized controlled trial from February 2014 to August 2015. WGS was...

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Bibliographic Details
Published in:Journal of antimicrobial chemotherapy 2018-03, Vol.73 (3), p.634-642
Main Authors: Harris, Patrick N A, Ben Zakour, Nouri L, Roberts, Leah W, Wailan, Alexander M, Zowawi, Hosam M, Tambyah, Paul A, Lye, David C, Jureen, Roland, Lee, Tau H, Yin, Mo, Izharuddin, Ezlyn, Looke, David, Runnegar, Naomi, Rogers, Benjamin, Bhally, Hasan, Crowe, Amy, Schembri, Mark A, Beatson, Scott A, Paterson, David L
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Australia - epidemiology
Bacteremia - epidemiology
Bacterial Typing Techniques
beta-Lactamases - biosynthesis
beta-Lactamases - genetics
Cephalosporins - pharmacology
Drug Resistance, Bacterial - genetics
Escherichia coli - classification
Escherichia coli - drug effects
Escherichia coli - genetics
Escherichia coli Infections - blood
Escherichia coli Infections - epidemiology
Female
Genome, Bacterial
Humans
Male
Middle Aged
Multilocus Sequence Typing
New Zealand - epidemiology
Phylogeny
Prevalence
Prospective Studies
Randomized Controlled Trials as Topic
Singapore - epidemiology
Whole Genome Sequencing
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Summary:To characterize MDR Escherichia coli from bloodstream infections (BSIs) in Australia, New Zealand and Singapore. We collected third-generation cephalosporin-resistant (3GC-R) E. coli from blood cultures in patients enrolled in a randomized controlled trial from February 2014 to August 2015. WGS was used to characterize antibiotic resistance genes, MLST, plasmids and phylogenetic relationships. Antibiotic susceptibility was determined using disc diffusion and Etest. A total of 70 3GC-R E. coli were included, of which the majority were ST131 (61.4%). BSI was most frequently from a urinary source (69.6%), community associated (62.9%) and in older patients (median age 71 years). The median Pitt score was 1 and ICU admission was infrequent (3.1%). ST131 possessed more acquired resistance genes than non-ST131 (P = 0.003). Clade C1/C2 ST131 predominated (30.2% and 53.5% of ST131, respectively) and these were all ciprofloxacin resistant. All clade A ST131 (n = 6) were community associated. The predominant ESBL types were blaCTX-M (80.0%) and were strongly associated with ST131 (95% carried blaCTX-M), with the majority blaCTX-M-15. Clade C1 was associated with blaCTX-M-14 and blaCTX-M-27, whereas blaCTX-M-15 predominated in clade C2. Plasmid-mediated AmpC genes (mainly blaCMY-2) were frequent (17.1%) but were more common in non-ST131 (P 
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkx466