Advances in Clinical and Experimental Medicine
2014, vol. 23, nr 6, November-December, p. 865–870
Publication type: original article
ESBL-Producing Escherichia coli Isolated from Bloodstream Infections – Antimicrobial Susceptibility, Conjugative Transfer of Resistance Genes and Phylogenetic Origin
1 Department of Microbiology, Wroclaw Medical University, Poland
Background. The prevalence of bloodstream infections (BSIs) due to ESBL-producing Escherichia coli (ESBL-EC) strains has increased dramatically over the past years.
Objectives. Characterization of ESBL-EC isolates collected from BSIs with regard to their antimicrobial susceptibility and phylogenetic background. The conjugative transfer of resistance determinants to the E. coli reference strain K12 C600 was also investigated.
Material and Methods. A collection of forty-eight ESBL-EC strains recovered from BSIs was subjected to the study. These strains were obtained from the ICU (intensive care unit) of the Medical University Hospital, Wrocław, Poland, during a four-year period (2009–2012). All the isolates were screened for ESBL production by the double disk synergy test (DDST). Transferability of plasmid-mediated resistance genes was performed by the conjugational broth method. Susceptibility to antibiotics and chemotherapeutics of clinical isolates and transconjugants was determined by the agar dilution method. PCR assay was used to detect the blaCTX-M gene in ESBL-EC tested and transconjugants. Affiliation to phylogenetic groups was done by the triplex PCR method.
Results. Conjugational transfer of plasmids responsible for ESBL to a recipient strain was successful for all the ESBL-EC analyzed (donors). The conjugation frequencies ranging from 2.3 × 10–7 to 5.2 × 10–1 per donor. In vitro susceptibility testing revealed that all the ESBL-EC isolates and their transconjugants were resistant to most of the antimicrobial agents tested with the exception of carbapenems, tigecycline, and β-lactam-clavulanate combinations. Moreover, all the donor strains and their transconjugants were found to contain the blaCTX-M gene. The majority of the isolates analyzed belonged to phylogroups B2 (62.5%) and D (25%), whereas groups B1 and A were less frequently represented (8.3% and 4.2%, respectively).
Conclusion. The results of the study confirm the need of antibiotic policies and effective infection control measures in hospital settings to minimize BSIs caused by multi-resistant ESBL-producing pathogens.
E. coli, ESBL, conjugational transfer, antimicrobial resistance, phylogenetic groups.
- Bush K, Jacoby GA: Updated functional classification of beta-lactamases. Antimicrob Agents Chemother 2010, 54, 969–976.
- Paterson DL, Bonomo RA: Extended-spectrum β-lactamases: a clinical update. Clin Microb Rev 2005, 18, 657–686.
- Franiczek R, Krzyżanowska B, Dolna I, Mokracka G, Szufnarowski K: Extended-spectrum β-lactamaseconferring transferable resistance to different antimicrobial agents in Enterobacteriaceae isolated from bloodstream infections. Folia Microbiol 2005, 50, 119–1124.
- Franiczek R, Dolna I, Krzyżanowska B, Szufnarowski K, Kowalska-Krochmal B: Transferable resistance to different antimicrobials due to CTX-M-type β-lactamases among Citrobacter freundii, Serratia marcescens, and Enterobacter spp. clinical isolates. Adv Clin Exp Med 2007, 16, 493–500.
- Stürenburg E, Mack D: Extended-spectrum β-lactamases: implications for the clinical microbiology laboratory, therapy, and infection control. J Infect 2003, 47, 273–295.
- Gudiol C, Calatayud L, Garcia-Vidal C, Lora-Tamayo J, Cisnal M, Duarte R, Arnan M, Marin M, Carratalà J, Gudiol F: Bacteraemia due to beta-lactamase-producing Escherichia coli (ESBL-EC) in cancer patients: clinical features, risk factors, molecular epidemiology and outcome. J Antimicrob Chemother 2010, 65, 333–341.
- Peirano G, van der Bij AK, Gregson DB, Pitout JD: Molecular epidemiology over an 11-year period (2000 to 2010) of extended-spectrum β-lactamase-producing Escherichia coli causing bacteremia in a centralized Canadian region. J Clin Microbiol 2012, 50, 294–299.
- Foxman B: Editorial commentary: extended-spectrum beta-lactamase-producing Escherichia coli in the United States: time to rethink empirical treatment for suspected E. coli infections? Clin Infect Dis 2013, 56, 649–651.
- Pena C, Gudiol C, Calatayud L, Tubau F, Dominguez MA, Pujol M, Ariza J, Gudiol F: Infections due to Escherichia coli producing extended-spectrum beta-lactamase among hospitalised patients: factors influencing mortality. J Hosp Infect 2008, 68, 116–122.
- Tumbarello M, Spanu T, Di Bidino R, Marchetti M, Ruggeri M, Trecarichi EM, De Pascale G, Proli EM, Cauda R, Cicchetti A, Fadda G: Costs of bloodstream infections caused by Escherichia coli and influence of extended-spectrum-beta-lactamase production and inadequate initial antibiotic therapy. Antimicrob Agents Chemother 2010, 54, 4085–4091.
- Drieux L, Brossier F, Sougakoff W, Jarlier V: Phenotypic detection of extended-spectrum beta-lactamase production in Enterobacteriaceae: review and bench guide. Clin Microbiol Infect 2008, 14, Suppl 1, 90–103.
- Clinical and Laboratory Standards Institute: Performance Standards for Antimicrobial Susceptibility Testing. Wayne PA, USA 2012, 22nd Informational Supplement, M100–S22.
- Clermont O, Bonacorsi S, Bingen E: Rapid and simple determination of the Escherichia coli phylogenetic group. Appl Environ Microbiol 2000, 66, 4555–4558.
- Ramphal R, Ambrose PG: Extended-spectrum beta-lactamases and clinical outcomes: current data. Clin Infect Dis 2006, 42, Suppl 4, 164–172.
- Östholm Balkhed Å, Tärnberg M, Monstein HJ, Hällgren A, Hanberger H, Nilsson LE: High frequency of coresistance in CTX-M-producing Escherichia coli to non-beta-lactam antibiotics, with the exceptions of amikacin, nitrofurantoin, colistin, tigecycline, and fosfomycin, in a county of Sweden. Scand J Infect Dis 2013, 45, 271–278.
- Heizmann WR, Dupont H, Montravers P, Guirao X, Eckmann C, Bassetti M, García MS, Capparella MR, Simoneau D, Bodmann KF: Resistance mechanisms and epidemiology of multiresistant pathogens in Europe and efficacy of tigecycline in observational studies. J Antimicrob Chemother 2013, 68 (Suppl. 2), 45–55.
- Humeniuk C, Arlet G, Gautier V, Grimont P, Labia R, Philippon A: β-lactamases of Kluyvera ascorbata, probable progenitors of some plasmid-encoded CTX-M types. Antimicrob Agents Chemother 2002, 46, 3045–3049.
- Livermore DM, Canton R, Gniadkowski M, Nordmann P, Rossolini GM, Arlet G, Ayala J, Coque TM, KernZdanowicz I, Luzzaro F, Poirel L, Woodford N: CTX-M: changing the face of ESBLs in Europe. J Antimicrob Chemother 2007, 59, 165–174.
- Cantón R, González-Alba JM, Galán JC: CTX-M enzymes: origin and diffusion. Front Microbiol 2012, 3, 1–19.
- Johnson JR, Delavari P, Kuskowski M, Stell AL: Phylogenetic distribution of extraintestinal virulence-associated traits in Escherichia coli. J Infect Dis 2001, 183, 78–88.
- Sannes MR, Kuskowski MA, Owens K, Gajewski A, Johnson JR: Virulence factor profiles and phylogenetic background of Escherichia coli isolates from veterans with bacteremia and uninfected control subjects. J Infect Dis 2004, 190, 2121–2128.
- Bukh AS, Schønheyder HC, Emmersen JM, Søgaard M, Bastholm S, Roslev P: Escherichia coli phylogenetic groups are associated with site of infection and level of antibiotic resistance in community-acquired bacteraemia: a 10 year population-based study in Denmark. J Antimicrob Chemother 2009, 64, 163–168.