scholarly journals The Niche for Escherichia coli Sequence Type 131 Among Veterans: Urinary Tract Abnormalities and Long-Term Care Facilities

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Dimitri M. Drekonja ◽  
Michael A. Kuskowski ◽  
Ruth Anway ◽  
Brian D. Johnston ◽  
James R. Johnson
Keyword(s):  
Escherichia Coli ◽  
Long Term Care ◽  
Severe Disease ◽  
Care Facility ◽  
Epidemiological Data ◽  
Initial Therapy ◽  
Sequence Type ◽  
Term Care ◽  
E Coli

Abstract Background.  Antimicrobial resistance among Escherichia coli is increasing, driven largely by the global emergence of sequence type 131 (ST131). However, the clinical significance of ST131 status is unknown. Among veterans, we assessed whether ST131 causes more severe, persistent, or recurrence-prone infections than non-ST131 E. coli. Methods.  Isolates were assessed by polymerase chain reaction for membership in ST131 and relevant subclones thereof (H30R and H30Rx) and by broth microdilution for susceptibility to 11 antibiotics. Clinical and epidemiological data were systematically abstracted from the medical record. Between-group comparisons were made using t tests and Fisher's exact test. Results.  Of the 311 unique E. coli isolates, 61 (19.6%) represented ST131. Of these, most (51 of 61, 83.6%) represented the H30R subclone; only 5 of 51 (9.8%) represented H30Rx. Relative to non-ST131 and non-H30R isolates, neither ST131 nor H30R were associated with more severe disease, worse clinical outcomes, or more robust hosts. Instead, both were more likely to be isolated from patients without manifestations of infection (for ST131, 36.1% vs 21.2% [P = .02]; for H30R, 39% vs 21% [P = .008]) and who had prior healthcare contact or long-term care facility (LTCF) exposure (for ST131, 33% vs 14% [P = .002]; for H30R, 37% vs 14% [P < .001]). Despite a greater likelihood of discordant initial therapy, outcomes did not differ between ST131 and H30R isolates vs other E. coli isolates. Conclusions.  Among veterans, ST131 and its H30R subclone were associated with LTCF-exposed hosts but not with worse outcomes.

scholarly journals Escherichia coli Sequence Type 131 Is a Dominant, Antimicrobial-Resistant Clonal Group Associated with Healthcare and Elderly Hosts

2013 ◽  
Vol 34 (4) ◽  
pp. 361-369 ◽  
Author(s):  
Ritu Banerjee ◽  
Brian Johnston ◽  
Christine Lohse ◽  
Stephen B. Porter ◽  
Connie Clabots ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Long Term Care ◽  
Tertiary Care ◽  
Sequence Type ◽  
Olmsted County ◽  
Term Care ◽  
Clonal Group ◽  
E Coli ◽  
Healthcare Settings

Objective.To determine prevalence, predictors, and outcomes of infection due to Escherichia coli sequence type ST131.Design.Retrospective cohort.Setting.All healthcare settings in Olmsted County, Minnesota (eg, community hospital, tertiary care center, long-term care facilities, and ambulatory clinics).Patients.Ambulatory and hospitalized children and adults with extraintestinal E. coli isolates.Methods.We analyzed 299 consecutive, nonduplicate extraintestinal E. coli isolates submitted to Olmsted County laboratories in February and March 2011. ST131 was identified using single-nucleotide polymorphism polymerase chain reaction and further evaluated through pulsed-field gel electrophoresis. Associated clinical data were abstracted through medical record review.Results.Most isolates were from urine specimens (90%), outpatients (68%), and community-associated infections (61%). ST131 accounted for 27% of isolates overall and for a larger proportion of those isolates resistant to fluoroquinolones (81%), trimethoprim-sulfamethoxazole (42%), gentamicin (79%), and ceftriaxone (50%). The prevalence of ST131 increased with age (accounting for 5% of isolates from those 11–20 years of age, 26% of isolates from those 51–60 years of age, and 50% of isolates from those 91–100 years of age). ST131 accounted for a greater proportion of healthcare-associated isolates (49%) than community-associated isolates (15%) and for fully 76% of E. coli isolates from long-term care facility (LTCF) residents. Multivariable predictors of ST131 carriage included older age, LTCF residence, previous urinary tract infection, high-complexity infection, and previous use of fluoroquinolones, macrolides, and extended-spectrum cephalosporins. With multivariable adjustment, ST131-associated infection outcomes included receipt of more than 1 antibiotic (odds ratio [OR], 2.54 [95% confidence interval (CI), 1.25–5.17]) and persistent or recurrent symptoms (OR, 2.53 [95% CI, 1.08–5.96]). Two globally predominant ST131 pulsotypes accounted for 45% of STB 1 isolates.Conclusions.ST131isa dominant, antimicrobial-resistant clonal group associated with healthcare settings, elderly hosts, and persistent or recurrent symptoms.

scholarly journals Long-Term Care Facilities Are Reservoirs for Antimicrobial-Resistant Sequence Type 131 Escherichia coli

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Mary J. Burgess ◽  
James R. Johnson ◽  
Stephen B. Porter ◽  
Brian Johnston ◽  
Connie Clabots ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Gel Electrophoresis ◽  
Long Term Care ◽  
Pulsed Field Gel Electrophoresis ◽  
Sequence Type ◽  
Term Care ◽  
E Coli ◽  
Care Facilities

Abstract Background.  Emerging data implicate long-term care facilities (LTCFs) as reservoirs of fluoroquinolone-resistant (FQ-R) Escherichia coli of sequence type 131 (ST131). We screened for ST131 among LTCF residents, characterized isolates molecularly, and identified risk factors for colonization. Methods.  We conducted a cross-sectional study using a single perianal swab or stool sample per resident in 2 LTCFs in Olmsted County, Minnesota, from April to July 2013. Confirmed FQ-R E. coli isolates underwent polymerase chain reaction-based phylotyping, detection of ST131 and its H30 and H30-Rx subclones, extended virulence genotyping, and pulsed-field gel electrophoresis (PFGE) analysis. Epidemiological data were collected from medical records. Results.  Of 133 fecal samples, 33 (25%) yielded FQ-R E. coli, 32 (97%) of which were ST131. The overall proportion with ST131 intestinal colonization was 32 of 133 (24%), which differed by facility: 17 of 41 (42%) in facility 1 vs 15 of 92 (16%) in facility 2 (P = .002). All ST131 isolates represented the H30 subclone, with virulence gene and PFGE profiles resembling those of previously described ST131 clinical isolates. By PFGE, certain isolates clustered both within and across LTCFs. Multivariable predictors of ST131 colonization included inability to sign consent (odds ratio [OR], 4.16 [P = .005]), decubitus ulcer (OR, 4.87 [ P = .04]), and fecal incontinence (OR, 2.59 [P = .06]). Conclusions.  Approximately one fourth of LTCF residents carried FQ-R ST131 E. coli resembling ST131 clinical isolates. Pulsed-field gel electrophoresis suggested intra- and interfacility transmission. The identified risk factors suggest that LTCF residents who require increased nursing care are at greatest risk for ST131 colonization, possibly due to healthcare-associated transmission.

scholarly journals Epidemiology of ESBL-producing Escherichia coli from repeated prevalence studies over 11 years in a long-term-care facility

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Romain Martischang ◽  
Patrice François ◽  
Abdessalam Cherkaoui ◽  
Nadia Gaïa ◽  
Gesuele Renzi ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Long Term Care ◽  
Rebound Effect ◽  
Temporal Trends ◽  
Care Facility ◽  
Control Measures ◽  
Term Care ◽  
E Coli ◽  
Contact Precautions

Abstract Background Escherichia coli sequence type (ST) 131 H30 is an emerging multidrug resistant subclone, known to spread and cause outbreaks in long-term care facilities (LTCFs). Objectives and methods From 2010 through 2020, we performed 11 yearly surveillance studies for determining the prevalence of digestive carriage of ESBL-producing E. coli (ESBL-EC) among residents in a university-affiliated LCTF. Sequencing and genotyping of selected isolates were performed to characterize temporal trends in the prevalence and epidemic potential of ESBL-EC subclones, and for evaluating a potential rebound effect following discontinuation of contact precautions for ESBL-EC carriers in January 2019. Results This study included 2′403 LTCF residents, with 252 (10.5%) positive for ESBL-EC. Among the 236 ESBL-EC isolates available for typing, 58.0% belonged to the ST131 lineage, including 94/137 (68.6%) ST131 H30 isolates. An increasing yearly prevalence was observed for ESBL-EC (from 4.6 to 9.4%; p = 0.11), but not for the ST131 H30 subclone, which peaked in 2015 and declined thereafter. Multiple previously unnoticed ESBL-EC outbreaks occurred in the LTCF. Since 2018, we noted the clonal expansion of a rare ST131 H89 subclone (O16:H5) harboring CTX-M-14 and CTX-M-24. No rebound effect was observed in ESBL-EC prevalence nor in the different subclones following discontinuation of contact precautions for ESBL-EC carriers since 2019. Conclusion Clonal fluctuation was observed for ST131 H30 ESBL-EC with a current decline in prevalence. Surveillance should include the evolution of ST131 non-H30 subclones, which may spread in LTCFs. Our findings suggest that discontinuation of contact precautions for ESBL-EC carriers in LTCFs may be safely implemented, in support of European recommendations to limit ESBL-producing Enterobacteriaceae control measures in endemic settings to non-E. coli.

scholarly journals Characterization of blaCTX-M-27/F1:A2:B20 Plasmids Harbored by Escherichia coli Sequence Type 131 Sublineage C1/H30R Isolates Spreading among Elderly Japanese in Nonacute-Care Settings

2020 ◽  
Vol 64 (5) ◽  
Author(s):  
Nao Matsuo ◽  
Rina Nonogaki ◽  
Michiko Hayashi ◽  
Jun-ichi Wachino ◽  
Masahiro Suzuki ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Care Facility ◽  
Sequence Type ◽  
Health Concern ◽  
Term Care ◽  
Content Type ◽  
Long Term Care Facility ◽  
Elderly Japanese

ABSTRACT We characterized 29 blaCTX-M-27-harboring plasmids of Escherichia coli sequence type 131 (ST131) sublineage C1/H30R isolates from healthy individuals and long-term-care facility (LTCF) residents. Most (27/29) plasmids were of the FIA, FIB, and FII multireplicon type with the same plasmid multilocus sequence typing (pMLST). Several plasmids (7/23) from LTCF residents harbored only blaCTX-M-27 as the resistance gene; however, their fundamental structures were very similar to those of previously isolated blaCTX-M-27/F1:A2:B20 plasmids, suggesting their prevalence as a newly arising public health concern.

scholarly journals Prolonged colonisation with Escherichia coli O25:ST131 versus other extended-spectrum beta-lactamase-producing E. coli in a long-term care facility with high endemic level of rectal colonisation, the Netherlands, 2013 to 2014

2016 ◽  
Vol 21 (42) ◽  
Author(s):  
Ilse Overdevest ◽  
Manon Haverkate ◽  
Jacobien Veenemans ◽  
Yvonne Hendriks ◽  
Carlo Verhulst ◽  
...  
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
Beta Lactamase ◽  
Term Care ◽  
Extended Spectrum Beta Lactamase ◽  
Long Term Care Facility ◽  
E Coli ◽  
Transmission Rates ◽  
Reproduction Numbers

The extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli clone ST131 (ESBL-ST131) has spread in healthcare settings worldwide. The reasons for its successful spread are unknown, but might include more effective transmission and/or longer persistence. We evaluated the colonisation dynamics of ESBL-producing E. coli (ESBL-EC), including ESBL-ST131, in a long-term care facility (LTCF) with an unusually high prevalence of rectal ESBL-EC colonisation. During a 14-month period, rectal or faecal samples were obtained from 296 residents during six repetitive prevalence surveys, using ESBL-selective culture. Transmission rates, reproduction numbers, and durations of colonisation were compared for ESBL-ST131 vs other ESBL-EC. Furthermore, the likely time required for ESBL-ST131 to disappear from the LTCF was estimated. Over time, the endemic level of ESBL-ST131 remained elevated whereas other ESBL-EC returned to low-level prevalence, despite comparable transmission rates. Survival analysis showed a half-life of 13 months for ESBL-ST131 carriage, vs two to three months for other ESBL-EC (p < 0.001). Per-admission reproduction numbers were 0.66 for ESBL-ST131 vs 0.56 for other ESBL-EC, predicting a mean time of three to four years for ESBL-ST131 to disappear from the LTCF under current conditions. Transmission rates were comparable for ESBL-ST131 vs other ESBL-EC. Prolonged rectal carriage explained the persistence of ESBL-ST131 in the LTCF.

Testing probiotic strain Escherichia coli Nissle 1917 (Mutaflor) for its ability to reduce carriage of multidrug-resistant E. coli by elderly residents in long-term care facilities

2011 ◽  
Vol 60 (3) ◽  
pp. 366-370 ◽  
Author(s):  
Gerald W. Tannock ◽  
Ing Soo Tiong ◽  
Patricia Priest ◽  
Karen Munro ◽  
Corinda Taylor ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Treatment Period ◽  
Long Term Care ◽  
Probiotic Strain ◽  
Multidrug Resistant ◽  
Term Care ◽  
E Coli ◽  
Multiresistant Bacteria ◽  
Care Facilities

A high carriage rate of multidrug-resistant Escherichia coli (MDREC) was observed in elderly residents in long-term care facilities. A double-blinded, placebo-controlled trial was carried out to determine whether the probiotic product E. coli strain Nissle 1917 (Mutaflor) would compete with MDREC in the bowel and thereby reduce the prevalence of the multiresistant bacteria in faeces and urine. Sixty-nine patients excreting norfloxacin-resistant E. coli were randomized to probiotic or placebo groups and administered capsules twice daily. The daily dose of probiotic was 5×109–5×1010 bacteria. Faecal and urine samples were cultured at baseline and during and after the treatment period. A reduction in baseline carriage was not influenced by probiotic administration. The probiotic strain was detected in faecal specimens collected during the treatment period of only two out of 12 probiotic group subjects that were tested. Genotyping of norfloxacin-resistant E. coli isolates showed that 32 strains were prevalent among the patients. Thus, E. coli Nissle 1917 does not have the capacity to compete effectively with MDREC in the bowel of elderly patients.

scholarly journals ESBL Types and Plasmid Heterogeneity in Urinary E. coli Isolates: Results From a Nationwide Multicenter Study in Croatia

2020 ◽  
Vol 41 (S1) ◽  
pp. s63-s64
Author(s):  
Tomislav Mestrovic ◽  
Marija Krilanovic ◽  
Maja Tomic-Paradzik ◽  
Natasa Beader ◽  
Zoran Herljevic ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Long Term Care ◽  
Regional Distribution ◽  
Care Facility ◽  
Multidrug Resistant ◽  
Resistance Pattern ◽  
Term Care ◽  
E Coli ◽  
Group 1

Background: The prevalence of Escherichia coli strains producing extended-spectrum β-lactamases (ESBLs) has increased both in the community and in healthcare settings. Furthermore, recent studies in nursing homes and long-term care facilities have shown that these institutions can act as potential reservoirs of ESBL- and CTX-M–producing E. coli. Consequently, we aimed to characterize ESBLs produced by E. coli isolates causing hospital-onset, long-term care facility and community infections throughout Croatia (Europe), as well as to compare antimicrobial sensitivity patterns, molecular specificities, plasmid types and epidemiological features. Methods: From a total pool of 16,333 E. coli isolates, 164 ESBL-producing strains with reduced susceptibility to third-generation cephalosporins were used for further appraisal. Phenotypic tests for the detection of ESBLs and plasmid-mediated AmpC β-lactamases were initially pursued (including a novel version of modified CIM test named cephalosporin inactivation method), followed by conjugation experiments, molecular detection of resistance genes, plasmid extraction with PCR-based replicon typing, serotyping, genotyping with pulsed-field gel electrophoresis, and whole-genome sequencing (WGS). Results: The isolates in this study exhibited a high level of resistance to expanded-spectrum cephalosporins and carried CTX-M or TEM β-lactamases, and all of them were classified as multidrug-resistant due to their resistance pattern to other antimicrobial drugs. The β-lactamase content did not differ among isolated E. coli strains from various sources (ie, hospitals, nursing homes, and the community). According to the genotyping results, the isolates were allocated into 8 clusters, which contained subclusters. Serotyping results revealed that O25 antigen was the dominant one; furthermore, isolates subjected to WGS belonged to the ST131 sequence type. The most pervasive plasmid types in the isolates from the country’s capital (Zagreb) were IncFII and FIA, whereas FIA alone was a dominant plasmid type in the southern part of the country. Conversely, eastern parts were characterized by plasmids belonging to IncB/O and IncW groups. Conclusions: Our study demonstrated the dissemination of group 1 CTX-M–positive E. coli not only in different geographic regions of Croatia but also in different arms of the healthcare system (ie, hospitals, nursing homes, and the community). Our results also confirmed the switch from previously pervasive SHV-2 and SHV-5 ESBLs to the nationwide predominance of group 1 CTX-M β-lactamases; however, regional distribution was associated with different plasmid types carrying blaCTX-M genes. These types of nationwide studies are indispensable for informing global decision making that addresses the issue of antimicrobial resistance.Funding: NoneDisclosures: None

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