Abstract
Longitudinal nationwide surveillance data on antimicrobial non-susceptibility and prevalence of extended-spectrum β-lactamases (ESBLs) as well as AmpC β-lactamases producers among Escherichia coli from different sources in the community settings are limited. Such data may impact treatment practice. The present study investigated E. coli from outpatients and patients visiting emergency rooms collected by the Taiwan Surveillance of Antimicrobial Resistance (TSAR) program. A total of 3481 E. coli isolates were studied, including 2153 (61.9%) from urine and 1125 (32.3%) from blood samples. These isolates were collected biennially between 2002 and 2012 from a total of 28 hospitals located in different geographic regions of Taiwan. Minimum inhibitory concentrations (MIC) were determined using methods recommended by the Clinical Laboratory Standards Institute (CLSI). The prevalence and factors associated with the presence of ESBL and AmpC β-lactamase-producers were determined. Significant increases in non-susceptibility to most β-lactams and ciprofloxacin occurred during the study period. By 2012, non-susceptibility to cefotaxime and ciprofloxacin reached 21.1% and 26.9%, respectively. The prevalence of ESBL- and AmpC- producers also increased from 4.0% and 5.3%, respectively, in 2002–2004, to 10.7% for both in 2010–2012 (P < 0.001). The predominant ESBL and AmpC β-lactamase genes were CTX-M and CMY-types, respectively. Non-susceptibility of urine isolates to nitrofurantoin remained at around 8% and to fosfomycin was low (0.7%) but to cefazolin (based on the 2014 CLSI urine criteria) increased from 11.5% in 2002–2004 to 23.9% in 2010–2012 (P <0.001). Non-susceptibility of isolates from different specimen types was generally similar, but isolates from elderly patients were significantly more resistant to most antimicrobial agents and associated with the presence of ESBL- and AmpC- β-lactamases. An additional concern is that decreased ciprofloxacin susceptibility (MIC 0.12–1 mg/L) was as high as 25% in isolates from all age groups, including those from pediatric patients. Our data indicated that there is a need to re-evaluate appropriate treatment selection for community-acquired infections in Taiwan. Identification of community reservoirs of multidrug-resistant E. coli is also warranted.
Highlights
Escherichia coli is the most common Gram-negative bacteria to cause various infection syndromes in humans, including urinary tract infections (UTI), bacteremia, meningitis, and gastrointestinal illnesses [1]
Fluoroquinolones and third generation cephalosporins are two groups of antibiotics usually recommended by therapeutic guidelines for treating infections caused by Enterobacteriaceae, including E. coli [5, 6], whereas nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin, may be considered for the treatment of uncomplicated and community-acquired UTI depending on the prevalence of resistance [5, 7]
The present study analyzed data from a nationwide surveillance program and revealed that over the past decade (2002 to 2012), significant increase in non-susceptibility to most β-lactam agents and ciprofloxacin occurred in E. coli isolates from community settings in Taiwan
Summary
Escherichia coli is the most common Gram-negative bacteria to cause various infection syndromes in humans, including urinary tract infections (UTI), bacteremia, meningitis, and gastrointestinal illnesses [1]. It is the leading cause of UTI and accounts for 70–95% of community-onset UTI cases [2]. In Europe, the overall FQ non-susceptibility of E. coli isolates from 2013 varied considerably between countries, from 11.7% in Norway to 51.9% in Cyprus [18] Such variations highlight the need for surveillance in each country to define the extent of the problem and help identify unusual resistance problems that exist locally [3]. These data can impact empirical therapy practices in each country
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