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

Published online by Cambridge University Press:  02 January 2015

Ritu Banerjee ,
Brian Johnston ,
Christine Lohse ,
Stephen B. Porter ,
Connie Clabots  and
James R. Johnson
Ritu Banerjee*
Affiliation:
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
Brian Johnston
Affiliation:
Veterans Affairs Medical Center and, University of Minnesota, Minneapolis, Minnesota
Christine Lohse
Affiliation:
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
Stephen B. Porter
Affiliation:
Veterans Affairs Medical Center and, University of Minnesota, Minneapolis, Minnesota
Connie Clabots
Affiliation:
Veterans Affairs Medical Center and, University of Minnesota, Minneapolis, Minnesota
James R. Johnson
Affiliation:
Veterans Affairs Medical Center and, University of Minnesota, Minneapolis, Minnesota
*
Division of Pediatric Infectious Diseases, 200 First Street SW, Rochester, MN 55905 (banerjee.ritu@mayo.edu)
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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 STB 1 isolates.

Conclusions.

ST131isa dominant, antimicrobial-resistant clonal group associated with healthcare settings, elderly hosts, and persistent or recurrent symptoms.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 4 , April 2013 , pp. 361 - 369
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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