Extraintestinal pathogenic &lt;i&gt;Escherichia coli&lt;/i&gt; in Saudi Arabia: A review of antimicrobial resistance and molecular epidemiology

Abdulaziz Alqasim

doi:10.4314/tjpr.v19i2.30

Abstract

Extra-intestinal pathogenic Escherichia coli (ExPEC) is commonly associated with causing urinary tract and bloodstream infections. Over the past two decades, the antimicrobial resistance of ExPEC has increasingly been reported [1]. Given that Saudi Arabia annually hosts mass religious events, such as Hajj, this review investigated several aspects of antimicrobial resistance of ExPEC in this country including the current prevalence of resistance and molecular epidemiology of ExPEC isolates. Generally, the overall prevalence of antibiotic resistance of ExPEC in Saudi Arabia is on increase. The current emergence of colistin resistance in ExPEC represents a major challenge to public health. Local molecular epidemiological studies have shown the dominance of E. coli sequence type 131 (E. coli ST131) over other major ExPEC STs. This is an important observation given that this clone has been associated with high multidrug resistance and extended-spectrum β-lactamases carriage. To reduce the burden of this resistance in the future, it would be crucial to avoid uncontrolled use of antibiotics in either clinical settings or animal food industry. Keywords: Extra-intestinal pathogenic Escherichia coli, Antimicrobial resistance, ST131, Saudi Arabia, Colistin resistance, Extended-spectrum β-lactamases

Highlights

Extra-intestinal pathogenic Escherichia coli (ExPEC) is associated with causing urinary tract infections (UTIs), bloodstream infections (BSIs), neonatal meningitis and pneumonia [2].In the recent years, the level of antibiotic resistance of E. coli, ExPEC, to firstline agents such as ciprofloxacin and cephalosporins, has increased markedly [1]
This review aimed to summarize the current knowledge of antimicrobial resistance of ExPEC in Saudi Arabia, focusing on the overall local prevalence of antimicrobial resistance and molecular epidemiology of ExPEC isolates
With regard to the prevalence of ESBL-producing ExPEC in Saudi Arabia, a previous study showed that the prevalence of ESBL-production among ExPEC isolates was 6.5 % in 2002 [21]

Summary

INTRODUCTION

Extra-intestinal pathogenic Escherichia coli (ExPEC) is associated with causing urinary tract infections (UTIs), bloodstream infections (BSIs), neonatal meningitis and pneumonia [2]. The majority of recently published reports have concluded that ExPEC isolates remained totally susceptible to imipenem and meropenem [9,16], AlYousef and others have demonstrated that 15 and 22.5 % of UPEC isolates were resistant to imipenem and ertapenem, respectively [8] (Table 1). With regard to the prevalence of ESBL-producing ExPEC in Saudi Arabia, a previous study showed that the prevalence of ESBL-production among ExPEC isolates was 6.5 % in 2002 [21] This prevalence has increased markedly, ranging between 20.4 and 41.9 % of ExPEC isolates [8, 9, 15, 16] (Table 2). ST448 isolates were associated with carrying the carbapenem resistance gene, blaOXA-181, while the ST23 isolates harbored the carbapenem resistance determinant, blaNDM-5

CONCLUDING REMARKS

Findings

Conflict of interest