Abstract
Escherichia coli represents one of the most common causes of community-onset and nosocomial infections. Strains carrying extended spectrum β-lactamases (ESBL) are a serious public health problem. In Central America we have not found studies reporting the molecular epidemiology of E. coli strains implicated in local infections, so we conducted this study to fill that gap. Materials and Methods: We report on an epidemiological study in two reference hospitals from central Panama, identifying the susceptibility profile, associated risk factors, and molecular typing of E. coli strains isolated between November 2018 and November 2019 using Pasteur’s Multilocus Sequence Typing (MLST) scheme. Results: A total of 30 E. coli isolates with antimicrobial resistance were analyzed, 70% of which came from inpatients and 30% from outpatients (p < 0.001). Two-thirds of the samples came from urine cultures. Forty-three percent of the strains were ESBL producers and 77% were resistant to ciprofloxacin. We identified 10 different sequence types (STs) with 30% of the ESBL strains identified as ST43, which corresponds to ST131 of the Achtman MLST scheme—the E. coli pandemic clone. Thirty-eight percent of the E. coli strains with the ESBL phenotype carried CTX-M-15. Conclusions: To the best of our knowledge, this is the first report confirming the presence of the pandemic E. coli clone ST43/ST131 harboring CTX-M-15 in Central American inpatients and outpatients. This E. coli strain is an important antimicrobial-resistant organism of public health concern, with potential challenges to treat infections in Panama and, perhaps, the rest of Central America.
Highlights
Escherichia coli represents one of the most frequent causes of bacterial infections [1] and it accounts for 70% to 95% of community-onset acute urinary tract infections (UTIs) and 50% of nosocomial infections [2]. β-Lactam antibiotics and fluoroquinolones are widely prescribed to treat both community- and hospital-based infections caused by E. coli [3]
A total of 30 isolates of E. coli with antimicrobial resistance were analyzed in this study, 20 (67%) of which came from urine cultures, and 5 each (16%) from blood and wound cultures (p < 0.001)
The antimicrobial resistance of the E. coli strains was as follows: 100% were susceptible to carbapenems and nitrofurantoin; while 13 (43%) were ESBL producers and 17 (57%) were non-ESBL producers
Summary
Escherichia coli represents one of the most frequent causes of bacterial infections [1] and it accounts for 70% to 95% of community-onset acute urinary tract infections (UTIs) and 50% of nosocomial infections [2]. β-Lactam antibiotics and fluoroquinolones are widely prescribed to treat both community- and hospital-based infections caused by E. coli [3]. Β-Lactam antibiotics and fluoroquinolones are widely prescribed to treat both community- and hospital-based infections caused by E. coli [3]. Resistance to these categories of antibiotics has increased worldwide, which represents a major public health problem. It has been reported that thirdgeneration cephalosporins and fluoroquinolones have registered resistance rates greater than 50% in five of the six working regions of the World Health Organization (WHO) [1,4,5]. Among the E. coli strains, the principal mechanism of resistance to β-Lactams is the production of β-lactamase enzymes, all of which differ from each other based on their substrate profile, inhibitor profile, and sequence homology [5]. Strains of ESBL-producing E. coli are important antimicrobial-resistant organisms (AROs). In 2017, the WHO defined a list of priority AROs for research purposes, among which ESBL-producing Enterobacteriaceae are in priority group 1 [9]
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