Fluoroquinolone-resistantEscherichia coli, Indonesia

Kuntaman Kuntaman,Irma M Kershof,James R Johnson,Prevalence And Prevention Study Group ,Usman Hadi,Juliëtte A Severin,Endang Sri Lestari,Henri A Verbrugh,Marijam Purwanta,Alex Van Belkum,On Behalf Of The Antimicrobial Resistance In Indonesia ,Ni Made Mertaniasih

doi:10.3201/eid1109.041207

Kuntaman Kuntaman, Irma M Kershof + Show 10 more

Open Access

https://doi.org/10.3201/eid1109.041207

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Abstract

In a recent, population-based survey of 3,996 persons in Indonesia, fluoroquinolone (FQ)-resistant Escherichia coli was prevalent in the fecal flora of 6% of patients at hospital admission and 23% of patients at discharge, but not among healthy relatives or patients visiting primary healthcare centers (2%). Molecular typing showed extensive genetic diversity with only limited clonality among isolates. This finding suggests that independent selection of resistant mutants occurs frequently. FQ-resistant isolates exhibited a higher rate of spontaneous mutation, but sparser virulence profiles, than FQ-susceptible isolates from the same population. The resistant isolates belonged predominantly to phylogenetic groups A (57%) and B1 (22%) but also to the moderately virulent group D (20%). Hypervirulent strains from the B2 cluster were underrepresented (1%). Because FQ-resistant E. coli can cause disease, especially nosocomial infections in immunocompromised patients, spread of such strains must be stopped.

Highlights

In a recent, population-based survey of 3,996 persons in Indonesia, fluoroquinolone (FQ)-resistant Escherichia coli was prevalent in the fecal flora of 6% of patients at hospital admission and 23% of patients at discharge, but not among healthy relatives or patients visiting primary healthcare centers (2%)
Strains harboring a robust extraintestinal virulence factors (VFs) repertoire cluster predominantly in groups B2 and D, isolates within each phylogenetic group can be further classified as extraintestinal pathogenic E. coli (ExPEC) or non-ExPEC depending on whether specific virulence traits are present [4,5]
The phylogenetic background and virulence profile of these isolates were determined by polymerase chain reactions (PCR) methods and compared with similar data for FQ-susceptible E. coli isolated from the same population

Summary

Introduction

Population-based survey of 3,996 persons in Indonesia, fluoroquinolone (FQ)-resistant Escherichia coli was prevalent in the fecal flora of 6% of patients at hospital admission and 23% of patients at discharge, but not among healthy relatives or patients visiting primary healthcare centers (2%). FQresistant E. coli from hospitalized Dutch patients derived predominantly from the low-virulence phylogenetic groups A and B1. Evidence suggests that clinical FQ-resistant E. coli isolates from humans in Iowa were associated with a shift toward nonB2 phylogenetic groups and to a lower overall virulence

Results

Conclusion