Irene Merino1, Evelyn Shaw2, Juan Pablo Horcajada3, Emilia Cercenado4, Beatriz Mirelis5, M Angeles Pallarés6, Juliá Gómez7, M Xercavins8, Luis Martínez-Martínez9, Marina De Cueto10, Rafael Cantón1, Patricia Ruiz-Garbajosa11. 1. Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain. 2. Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain. 3. Departamento de Enfermedades Infecciosas, Hospital del Mar and Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain CEXS-Universitat Pompeu Fabra, Barcelona, Spain. 4. Servicio de Microbiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 5. Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain Servicio de Microbiología, Hospital Santa Creu i Sant Pau, Barcelona, Spain. 6. Servicio de Microbiología, Complexo Hospitalario de Pontevedra, Pontevedra, Spain. 7. Laboratori de Referència de Catalunya, Barcelona, Spain. 8. Servicio de Microbiología, Catlab, Hospital Universitari Mútua de Terrassa, Terrassa, Spain. 9. Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain Servicio de Microbiología, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain. 10. Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain. 11. Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain pruizg@salud.madrid.org.
Abstract
OBJECTIVES: The objective of this study was to assess the prevalence and molecular epidemiology of ESBL-producing Escherichia coli causing healthcare-associated (HCA) and community-associated (CA) bacteraemia of urinary origin (BUO) in Spain. METHODS: An observational cohort study was conducted at eight hospitals from different Spanish geographical areas (2010-11). BUO episodes (n = 425) were classified as HCA (n = 215) and CA (n = 210), and one blood isolate per episode was collected. Susceptibility testing was performed, ESBLs were screened by double-disc diffusion test and ESBL and OXA-1 genes were characterized (PCR and sequencing). Population structure (phylogenetic groups, XbaI-PFGE and MLST) and ST131 subtyping (PCR) were determined. Virulence genes were detected by PCR and virulence score, profiles and extraintestinal pathogenic E. coli (ExPEC) status calculated. RESULTS: ESBL-producing E. coli prevalence was 9.2% (39/425). ESBL-producing E. coli episodes were significantly associated with HCA-BUO episodes [14% (30/215) versus 4.3% (9/210); P = 0.001]. The highest non-susceptibility proportions corresponded to ciprofloxacin (97.4%), amoxicillin/clavulanate (74.4%), co-trimoxazole (69.2%) and tobramycin (61.5%). Of the 39 ESBL-producing E. coli isolates, 34 produced CTX-M enzymes (21 CTX-M-15, 11 CTX-M-14 and 2 CTX-M-1). Fifteen STs were identified, the B2-ST131 clone being the most prevalent (54%; 21/39). All ST131 isolates were ExPEC and had the highest virulence scores, but they showed less diversity in virulence profiles than other STs. The H30Rx subclone accounted for most ST131 isolates (20/21), co-produced CTX-M-15 (20/20) and OXA-1 (19/20) enzymes and was associated with HCA episodes (16/20). CONCLUSIONS: The CTX-M-15-ST131-H30Rx subclone is a relevant MDR pathogen causing BUO, mainly HCA episodes. The dominance of this subclone with comparatively less diversity of virulence profiles reflects the spread of a successful and MDR ESBL ST131 lineage in Spain.
OBJECTIVES: The objective of this study was to assess the prevalence and molecular epidemiology of ESBL-producing Escherichia coli causing healthcare-associated (HCA) and community-associated (CA) bacteraemia of urinary origin (BUO) in Spain. METHODS: An observational cohort study was conducted at eight hospitals from different Spanish geographical areas (2010-11). BUO episodes (n = 425) were classified as HCA (n = 215) and CA (n = 210), and one blood isolate per episode was collected. Susceptibility testing was performed, ESBLs were screened by double-disc diffusion test and ESBL and OXA-1 genes were characterized (PCR and sequencing). Population structure (phylogenetic groups, XbaI-PFGE and MLST) and ST131 subtyping (PCR) were determined. Virulence genes were detected by PCR and virulence score, profiles and extraintestinal pathogenic E. coli (ExPEC) status calculated. RESULTS: ESBL-producing E. coli prevalence was 9.2% (39/425). ESBL-producing E. coli episodes were significantly associated with HCA-BUO episodes [14% (30/215) versus 4.3% (9/210); P = 0.001]. The highest non-susceptibility proportions corresponded to ciprofloxacin (97.4%), amoxicillin/clavulanate (74.4%), co-trimoxazole (69.2%) and tobramycin (61.5%). Of the 39 ESBL-producing E. coli isolates, 34 produced CTX-M enzymes (21 CTX-M-15, 11 CTX-M-14 and 2 CTX-M-1). Fifteen STs were identified, the B2-ST131 clone being the most prevalent (54%; 21/39). All ST131 isolates were ExPEC and had the highest virulence scores, but they showed less diversity in virulence profiles than other STs. The H30Rx subclone accounted for most ST131 isolates (20/21), co-produced CTX-M-15 (20/20) and OXA-1 (19/20) enzymes and was associated with HCA episodes (16/20). CONCLUSIONS: The CTX-M-15-ST131-H30Rx subclone is a relevant MDR pathogen causing BUO, mainly HCA episodes. The dominance of this subclone with comparatively less diversity of virulence profiles reflects the spread of a successful and MDR ESBL ST131 lineage in Spain.
Authors: Amee R Manges; Hyun Min Geum; Alice Guo; Thaddeus J Edens; Chad D Fibke; Johann D D Pitout Journal: Clin Microbiol Rev Date: 2019-06-12 Impact factor: 26.132
Authors: Marta Fernández-Martínez; Belén Ruiz Del Castillo; Maria Jesús Lecea-Cuello; Jesús Rodríguez-Baño; Álvaro Pascual; Luis Martínez-Martínez Journal: Microb Drug Resist Date: 2017-10-03 Impact factor: 3.431
Authors: Ana Carolina C Campos; Nathália L Andrade; Mithila Ferdous; Monika A Chlebowicz; Carla C Santos; Julio C D Correal; Jerome R Lo Ten Foe; Ana Cláudia P Rosa; Paulo V Damasco; Alex W Friedrich; John W A Rossen Journal: Front Microbiol Date: 2018-02-16 Impact factor: 5.640
Authors: Irene Merino; Stephen B Porter; Brian D Johnston; Connie Clabots; Evelyn Shaw; Juan Pablo Horcajada; Rafael Cantón; Patricia Ruiz-Garbajosa; James R Johnson Journal: PLoS One Date: 2017-11-30 Impact factor: 3.240