Nahid Karami1, Anna Lindblom2, Shora Yazdanshenas3, Viktoria Lindén3, Christina Åhrén4. 1. Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden; Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: nahid.karami@microbio.gu.se. 2. Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden; Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 3. Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 4. Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden; Swedish Strategic Program against Antimicrobial Resistance (Strama), Region Västra Götaland, Gothenburg, Sweden.
Abstract
OBJECTIVES: Bacterial features associated with recurrent urinary tract infections (RUTIs) due to extended-spectrum β-lactamase-producingEscherichia coli (ESBL-E. coli) are not well understood. In this study, phylogenetic groups and ST131 subclones were investigated to assess strain homology of ESBL-E. coli isolates in patients with RUTIs in inpatient and outpatient settings in western Sweden. METHODS: Almost all isolates (319/356) from 123 patients with 2-7 episodes (median 2 episodes) of ESBL-E. coli UTI within 1 year were examined for seven E. coli phylogroups, the ST131-O25b clone and its subclone fimH30-Rx. Antimicrobial resistance and ESBL genes were determined for the index isolates. A subset of isolates was typed using pulsed-field gel electrophoresis (PFGE). RESULTS: The same phylogroup and ST131 subclones were seen for all recurrences in 119/123 patients, and PFGE confirmed strain homology in recurrences for 43/44 patients tested. Phylogroup B2 dominated (56%), followed by D (19%) and F (10%). ST131-O25b andfimH30-Rx isolates were detected in 44% and 30%, respectively. CTX-M group 1 (71%) predominated. Elderly patients were in the majority. There were no associations between patient demographics or time to recurrence and bacterial characteristics. The fimH30-Rx subclone was associated with a higher number of recurrences (P = 0.015) compared with the remaining B2 isolates. CONCLUSION: In ESBL-E. coli RUTI, most recurrences were caused by the initial infecting strain. The high frequency of the multidrug-resistant fimH30-Rx subclone and its association with multiple recurrences warrants further attention and early detection of this subclone in patients at risk of developing RUTI with ESBL-E. coli.
OBJECTIVES: Bacterial features associated with recurrent urinary tract infections (RUTIs) due to extended-spectrum β-lactamase-producingEscherichia coli (ESBL-E. coli) are not well understood. In this study, phylogenetic groups and ST131 subclones were investigated to assess strain homology of ESBL-E. coli isolates in patients with RUTIs in inpatient and outpatient settings in western Sweden. METHODS: Almost all isolates (319/356) from 123 patients with 2-7 episodes (median 2 episodes) of ESBL-E. coli UTI within 1 year were examined for seven E. coli phylogroups, the ST131-O25b clone and its subclone fimH30-Rx. Antimicrobial resistance and ESBL genes were determined for the index isolates. A subset of isolates was typed using pulsed-field gel electrophoresis (PFGE). RESULTS: The same phylogroup and ST131 subclones were seen for all recurrences in 119/123 patients, and PFGE confirmed strain homology in recurrences for 43/44 patients tested. Phylogroup B2 dominated (56%), followed by D (19%) and F (10%). ST131-O25b andfimH30-Rx isolates were detected in 44% and 30%, respectively. CTX-M group 1 (71%) predominated. Elderly patients were in the majority. There were no associations between patient demographics or time to recurrence and bacterial characteristics. The fimH30-Rx subclone was associated with a higher number of recurrences (P = 0.015) compared with the remaining B2 isolates. CONCLUSION: In ESBL-E. coli RUTI, most recurrences were caused by the initial infecting strain. The high frequency of the multidrug-resistant fimH30-Rx subclone and its association with multiple recurrences warrants further attention and early detection of this subclone in patients at risk of developing RUTI with ESBL-E. coli.
Authors: Catarina Bourgard; Diego Rodríguez-Hernández; Anastasia Rudenko; Carolin Rutgersson; Martin Palm; D G Joakim Larsson; Anne Farewell; Morten Grøtli; Per Sunnerhagen Journal: Antibiotics (Basel) Date: 2022-08-17
Authors: Nahid Karami; Sriram Kk; Shora Yazdanshenas; Yii-Lih Lin; Daniel Jaén-Luchoro; Elina Ekedahl; Sanjana Parameshwaran; Anna Lindblom; Christina Åhrén; Fredrik Westerlund Journal: Microorganisms Date: 2021-05-25