Abstract
Extra-intestinal pathogenic Escherichia coli (ExPEC) is one of the world’s leading causes of bloodstream infections with high mortality. Sequence type 410 (ST410) is an emerging ExPEC clone resistant to a wide range of antibiotics. In this study, we investigated the epidemiology of 21 ST410 E. coli isolates from two Ghanaian hospitals. We also investigated the isolates within a global context to provide further insight into the dissemination of this highly pathogenic clone. A phylogenetic tree of the 21 isolate genomes, along with 102 others from global collection, was constructed representing the ensuing clades and sub-clades of the ST: A/H53, B2/H24R, B3/H24Rx, and B4/H24RxC. The carbapenem-resistant sub-clade B4/H24RxC is reported to have emerged in the early 2000s when ST410 acquired an IncX3 plasmid carrying a blaOXA–181 carbapenemase gene, and a second carbapenemase gene, blaNDM–5, on a conserved IncFII plasmid in 2014. We identified, in this study, one blaOXA–181–carrying isolate belonging to B4/H24RxC sub-lineage and one carrying blaNDM–1 belonging to sub-lineage B3/H24Rx. The blaOXA–181 gene was found on a 51kb IncX3 plasmid; pEc1079_3. The majority (12/21) of our Ghanaian isolates were clustered with international strains described by previous authors as closely related strains to B4/H24RxC. Six others were clustered among the ESBL-associated sub-lineage B3/H24Rx and three with the globally disseminated sub-lineage B4/H24RxC. The results show that this highly pathogenic clone is disseminated in Ghana and, given its ability to transmit between hosts, it poses a serious threat and should be monitored closely.
Highlights
The World Health Organization (WHO) in its 2014 report hinted of a looming medical health crisis on account of the rapid evolution and dissemination of antibiotic resistant strains
Escherichia coli sequence type 410 (ST410) is an emerging multidrug-resistant pathogenic clone that belongs to a group of strains called extra-intestinal pathogenic E. coli (ExPEC), responsible for the wide spectrum of invasive extra-intestinal infections (Roer et al, 2018)
Similar to ST131, ST410 has successfully been established as another ExPEC clone (Roer et al, 2018), with extended spectrum beta lactamases (ESBLs) genes as the primary factors driving the spread of such resistance clones (Schaufler et al, 2016)
Summary
The World Health Organization (WHO) in its 2014 report hinted of a looming medical health crisis on account of the rapid evolution and dissemination of antibiotic resistant strains. Escherichia coli sequence type 410 (ST410) is an emerging multidrug-resistant pathogenic clone that belongs to a group of strains called extra-intestinal pathogenic E. coli (ExPEC), responsible for the wide spectrum of invasive extra-intestinal infections (Roer et al, 2018). It is known to belong to phylogroup A, a group thought to comprise mildly virulent commensal bacteria, and is possibly the reason why ST410 has not attained global prominence (Falgenhauer et al, 2016; Roer et al, 2018). Further evidence has shown that bacteria in this phylogroup can cause life-threating infections such as sepsis, and capable of elaborating different virulence factors (Chakraborty et al, 2015; Falgenhauer et al, 2016). In Northern America, Europe, and Southeast Asia, this clone appears to be prevalent, in addition to a fluoroquinolone- and extended-spectrum cephalosporin– resistant sub-clade B3/H24Rx (Nadimpalli et al, 2019)
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