Escherichia coli Sequence Type 131 (ST131) Subclone H30 as an Emergent Multidrug-Resistant Pathogen Among US Veterans

Background. Escherichia coli sequence type 131 (ST131), typically fluoroquinolone-resistant (FQ-R) and/or extended-spectrum β-lactamase (ESBL)–producing, has emerged globally. We assessed its prevalence and characteristics among US veterans. Methods. In 2011, 595 de-identified E. coli clinical isola...

Full description

Saved in:
Bibliographic Details
Published in:Clinical infectious diseases 2013-11, Vol.57 (9), p.1256-1265
Main Authors: Colpan, Aylin, Johnston, Brian, Porter, Stephen, Clabots, Connie, Anway, Ruth, Thao, Lao, Kuskowski, Michael A., Tchesnokova, Veronika, Sokurenko, Evgeni V., Johnson, James R.
Format: Article
Language:English
Subjects:
Abbreviations
and Commentaries
Anti-Bacterial Agents - pharmacology
Antibiotic resistance
Antimicrobials
ARTICLES AND COMMENTARIES
beta-Lactams - pharmacology
Biological and medical sciences
Drug resistance
Drug Resistance, Multiple, Bacterial
E coli
Epidemiology
Escherichia coli
Escherichia coli - classification
Escherichia coli - drug effects
Escherichia coli - genetics
Escherichia coli - isolation & purification
Escherichia coli Infections - epidemiology
Escherichia coli Infections - microbiology
Escherichia coli Proteins - genetics
Fluoroquinolones - pharmacology
Genotype
Genotypes
Humans
Infections
Infectious diseases
Intramuscular injections
Medical sciences
Molecular Epidemiology
Molecular Typing
Phenotypes
Polymerase Chain Reaction
Population estimates
Prevalence
United States - epidemiology
Veterans
Virulence
Virulence Factors - genetics
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background. Escherichia coli sequence type 131 (ST131), typically fluoroquinolone-resistant (FQ-R) and/or extended-spectrum β-lactamase (ESBL)–producing, has emerged globally. We assessed its prevalence and characteristics among US veterans. Methods. In 2011, 595 de-identified E. coli clinical isolates were collected systematically within 3 resistance groups (FQ-susceptible [FQ-S], FQ-R, and ESBL-producing) from 24 nationally distributed Veterans Affairs Medical Centers (VAMCs). ST131 and its H30 subclone were detected by polymerase chain reaction and compared with other E. coli for molecular traits, source, and resistance profiles. Results. ST131 accounted for 78% (184/236) of FQ-R and 64.2% (79/123) of ESBL-producing isolates, but only 7.2% (17/236) of FQ-S isolates (P < .001). The H30 subclone accounted for ≥95% of FQ-R and ESBL-producing, but only 12.5% of FQ-S, ST131 isolates (P < .001). By back-calculation, 28% of VAMC E. coli isolates nationally represented ST131. Overall, ST131 varied minimally in prevalence by specimen type, inpatient/outpatient source, or locale; was the most prevalent ST, followed distantly by ST95 and ST12 (13% each); and accounted for ≥40% (β-lactams), >50% (trimethoprim-sulfamethoxazole, multidrug), or >70% (ciprofloxacin, gentamicin) of total antimicrobial resistance. FQ-R and ESBL-producing ST131 isolates had higher virulence scores than corresponding non-ST131 isolates. ST131 pulsotypes overlapped extensively among VAMCs. Conclusions. Among US veterans, ST131, primarily its H30 subclone, accounts for most antimicrobial-resistant E. coli and is the dominant E. coli strain overall. Possible contributors include multidrug resistance, extensive virulence gene content, and ongoing transmission. Focused attention to ST131, especially its H30 subclone, could reduce infection-related morbidity, mortality, and costs among veterans.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/cit503