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. 2013 Apr;34(4):361-9.
doi: 10.1086/669865. Epub 2013 Feb 13.

Escherichia coli sequence type 131 is a dominant, antimicrobial-resistant clonal group associated with healthcare and elderly hosts

Ritu Banerjee  1 , Brian Johnston, Christine Lohse, Stephen B Porter, Connie Clabots, James R Johnson
Affiliations

Escherichia coli sequence type 131 is a dominant, antimicrobial-resistant clonal group associated with healthcare and elderly hosts

Ritu Banerjee et al. Infect Control Hosp Epidemiol. 2013 Apr.

Abstract

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 ST131 isolates.

Conclusions: ST131 is a dominant, antimicrobial-resistant clonal group associated with healthcare settings, elderly hosts, and persistent or recurrent symptoms.

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Conflict of interest statement

Potential conflicts of interest. J.R.J. has received research grants or contracts from Merck, Rochester Medical, and Syntiron. All other authors report no conflicts of interest relevant to this article. All authors submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and the conflicts that the editors consider relevant to this article are disclosed here.

Figures

FIGURE 1
FIGURE 1
Prevalence of sequence type (ST) 131 according to age cohort in years (Y). Percentage of isolates within each age cohort that are ST131 is shown above the corresponding point in the graph. The number of patients per age cohort is shown in parentheses below the X-axis. The P value is from a univariable logistic regression model for the association of age with ST131 status.
FIGURE 2
FIGURE 2
Pulsed-field gel electrophoresis (PFGE) profile dendrogram for 80 sequence type (ST) 131 Escherichia coli isolates from Olmsted County, Minnesota, February–March 2011. Bullets indicate the presence of the characteristic, and blank spaces indicate the absence of the characteristic. FQ-R, fluoroquinolone resistant; LTCF, long-term care facility.
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