Prevalence and genomic characterization of pathogenic blaNDM-positive Escherichia coli from retail meats: The first large-scale study in 22 cities of China.

High prevalence and transmission of blaNDM-positive Escherichia coli between farmed ducks and slaughtered meats: An increasing threat to food safety

ABSTRACTThis 4-month-long prospective observational study investigated the epidemiological characteristics, genetic composition, transmission pattern, and infection control of carbapenem-resistant Escherichia coli (CREC) colonization in patients at an intensive care unit (ICU) in China. Phenotypic confirmation testing was performed on nonduplicated isolates from patients and their environments. Whole-genome sequencing was performed for all E. coli isolates, followed by multilocus sequence typing (MLST), and antimicrobial resistance genes and single nucleotide polymorphisms (SNPs) were screened. The colonization rates of CREC were 7.29% from the patient specimens and 0.39% from the environmental specimens. Among the 214 E. coli isolates tested, 16 were carbapenem resistant, with the blaNDM-5 gene identified as the dominant carbapenemase-encoding gene. Among the low-homology sporadic strains isolated in this study, the main sequence type (ST) of carbapenem-sensitive Escherichia coli (CSEC) was ST1193, whereas the majority of CREC isolates belonged to ST1656, followed by ST131. CREC isolates were more sensitive to disinfectants than were the carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates obtained in the same period, which may explain the lower separation rate. Therefore, effective interventions and active screening are beneficial to the prevention and control of CREC.IMPORTANCE CREC represents a public health threat worldwide, and its colonization precedes or occurs simultaneously with infection; once the colonization rate increases, the infection rate rises sharply. In our hospital, the colonization rate of CREC remained low, and almost all of the CREC isolates detected were ICU acquired. Contamination of the surrounding environment by CREC carrier patients shows a very limited spatiotemporal distribution. As the dominant ST of the CSEC isolates found, ST1193 CREC might be considered a strain of notable concern with potential to cause a future outbreak. ST1656 and ST131 also deserve attention, as they comprised the majority of the CREC isolates found, while blaNDM-5 gene screening should play an important role in medication guidance as the main carbapenem resistance gene identified. The disinfectant chlorhexidine, which is used commonly in the hospital, is effective for CREC rather than CRKP, possibly explaining the lower positivity rate for CREC than for CRKP.

1. The aim of this work was to compare a group of virulence-associated characteristics of Escherichia coli isolates from broiler chickens that had died with signs of colibacillosis against E. coli isolates from ready-to-market chicken meat in the West Bank.2. The isolates were investigated to determine the virulence factor (VF) profile, phylogenetic group and the presence of extended-spectrum beta-lactamase (ESBL). A total of 66 avian pathogenic E. coli (APEC) strains from different affected broiler farms and 21 E. coli isolates from ready-to-market chicken carcasses (hereinafter called meat strains) from 8 slaughter houses were analysed.3. The overall content of VFs was significantly higher (P < 0.05) among APEC strains, with over 75% of APEC strains having ≥4 VFs, while over 75% of the meat strains had <4 VFs. The VFs iss, astA and iucD were frequently detected in APEC and meat strains, whereas cvi, papC, vat, tsh and irp2 occurred more significantly in APEC strains. Phylogenetic typing showed that 67% of the meat strains belonged to group B2. Phylogroup D was predominant (50%) in the APEC strains. Using double disc diffusion and polymerase chain reaction (PCR), 10.6% of the APEC and 9.5% of the meat strains were determined to be ESBL positive.4. Our findings show that the VFs papC, vat, irp2 and to a lesser extent tsh and cvi are significantly more prevalent in APEC strains. The results demonstrate that chicken meat can be contaminated with APEC strains (≥4 VF). A significant percentage of the meat strains fall in the B2 group, which is a phylogroup largely associated with human pathogenic ExPEC strains. The results of ESBL screening indicated that broiler chicken products in Palestine represent a potential reservoir of ESBL genes and therefore could be considered a possible public health risk.

The continuous emergence of carbapenem-resistant Escherichia coli (CRECO) presents a great challenge to public health. New Delhi metallo-lactamase (NDM) variants are widely disseminated in China, so the research on the prevalence and transmission of diverse blaNDM variants is urgently needed. In the present study, 54 CRECO isolates were collected from 1,185 Escherichia coli isolates in five hospitals in Northern Jiangsu Province, China from September 2015 to August 2016. Antimicrobial susceptibility tests, PCR detection of resistance determinants, multi-locus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) were performed to characterize these strains. Plasmid conjugation experiments were carried out to determine the transferability of resistant genes from selected isolates. PCR-based replicon typing (PBRT), S1 nuclease-PFGE, and Southern blotting were conducted for plasmid profiling. Carbapenemase genes were detectable in all CRECO isolates, among which thirty-one CRECO isolates were found to carry blaNDM−5 (54.7%), while, blaNDM−1, blaNDM−7, blaNDM−4, blaNDM−9, and blaKPC−2 were identified in 14, five, two, one, and one isolates, respectively. MLST results revealed 15 different STs and four new STs were first reported to be linked with NDM-producing isolates. PFGE typing showed that no more than two isolates with the same ST appeared to the same band pattern except three ST410 isolates. Twenty-six selected NDM-producing isolates were successfully transferred to E. coli J53 by conjugation experiments. Notably, 50.0% (13/26) of blaNDM variants were found to be carried by ~55 kb IncX3 plasmid. Our study reported a high prevalence of blaNDM variants, especially blaNDM−5, in Northern Jiangsu province, China. Diverse blaNDM variants were mainly carried by ~55 kb IncX3 plasmids, suggesting that the fast evolution and high transferability of this kind of plasmid promote the high prevalence of blaNDM variants. Therefore, large-scale surveillance and effective infection control measures are also urgently needed to prevent diverse blaNDM variants from becoming epidemic in the future.

Background: Avian pathogenic E. coli (APEC) and uropathogenic E. coli (UPEC) are responsible, respectively, for avian colibacillosis and for 80% of urinary tract infections in humans. E. coli control is difficult due to the absence of a reliable method to differentiate pathogenic and commensal strains. Genetic similarity between APEC and UPEC suggests a common ancestral origin and the capability of potentially pathogenic strains to affect human health. The classification in phylogenetic groups facilitates the identification of pathogenic strains. The objective of this work was to classify APEC and UPEC E. coli strains into phylogenetic groups and to associate it with in vivo pathogenicity.Materials, Methods &amp; Results: 460 APEC and 450 UPEC strains, stored in BHI with glycerol at -80°C, were selected. APEC strains were isolated from cellulitis, respiratory tract and poultry litter of broiler flocks from Southern Brazil. The UPEC strains from urinary tract infection were provided by a hospital in Porto Alegre. After DNA extraction, APEC and UPEC strains were classified into four phylogenetic groups (A, B1, B2 and D) by a multiplex-PCR protocol for the detection of the chuA and yjaA genes and the TspE4.C2 DNA fragment. Phylogenetic groups were associated with pathogenicity indexes (PI), presented on a scale of 0 to 10, which were previously obtained through the inoculation of APEC strains in one-day-old chicks. Phylogenetic groups were also associated with the presence of 38 virulence-associated genes. The multiplex-PCR protocol was able to differentiate 100% of the APEC and UPEC strains in the four phylogenetic groups. The majority of APEC strains were classified into phylogenetic groups D (31.1%) and B2 (24.1%). On the other hand, the majority of UPEC strains were classified into B2 (53.6%). Among APEC strains, five genes (crl, mat, ompA, fimC and fimH) were detected in more than 80% of strains in all groups. Some genes showed a significant association with specific phylogenetic groups. Gene ireA was exclusively to group D, kpsMT II and cvaC to B2 and sat was exclusively to B1. Four genes (ireA, sfa/focCD, ibeA, tsh) were detected in more than 70% of UPEC strains in all phylogenetic groups. Gene iroN1 showed a significant association exclusively to group A, and iucD, papC and irp2 to B1 group. APEC isolated from poultry litter presented significantly lower PIs than those isolated from cellulitis and from birds with respiratory signs. The average PI from B2 group was significantly higher than that of D group. In addition, the PIs of the two groups were significantly higher than those of A and B1.Discussion: The high frequency of UPEC classified as B2 is in agreement with the literature. More virulent strains are usually classified into B2 group and some of them may be classified into D group. On the other hand, the distribution of APEC isolates in phylogenetic groups is characterized by variability and it is usually related to the origin of the isolates, as observed in the study. Since E. coli strains isolated from human and poultry face similar challenges in infection establishment of extraintestinal sites, they may share some virulence genes. In this study, most of the 38 genes presented a high frequency in both APEC and UPEC strains. As the distribution of APEC strains in phylogenetic groups showed a significant association with pathogenicity, multiplex-PCR becomes an important tool for screening the pathogenicity of strains isolated from the poultry production chain.

Transmission of Carbapenem Resistance Between Human and Animal NDM-Positive Escherichia coli Strains

Carbapenem-resistant Escherichia coli (CREC), particularly strains producing New Delhi metallo-β-lactamase-9 (NDM-9), pose a growing threat as agents of nosocomial infections. Despite their emergence since 2013, a comprehensive global phylogeographic and genetic characterization of blaNDM-9-carrying CREC is lacking. Through 7 years (2018-2024) of surveillance of CREC strains in a tertiary hospital, we obtained seven blaNDM-9-carrying CREC. Antimicrobial susceptibility testing, conjugative transfer experiments, whole-genome sequencing (WGS), and fitness analysis were performed. Publicly available genomes of blaNDM-9-carrying CREC from NCBI (curated by July 2025) were integrated for global analysis. All seven blaNDM-9-carrying CREC exhibited resistance to most antimicrobials tested, except colistin. WGS revealed diverse blaNDM-9-carrying plasmid types (IncB/O/K/Z, IncHI2, IncFIB, and IncC) and sequence types of strains (ST156 predominant). Key mobile genetic elements IS26 and ISCR1 facilitated blaNDM-9 dissemination. Plasmid structural analysis traced the evolution of the IncB/O/K/Z plasmid, revealing potential intra-hospital persistence and spread. Carriage of blaNDM-9-carrying plasmid imposed a significant fitness cost. Global analysis (n = 203 isolates) demonstrated high genetic diversity (56 STs), with ST156 (20.1%) being the most prevalent. Spatially, isolates were concentrated in Asia (China: 85.2%). Primary isolation sources were humans (39.4%) and chickens (34.9%), with a notable shift toward human predominance since 2016. Our findings elucidate the critical role of specific mobile elements in transmission, highlight the significant burden in China, document a shift toward human-associated isolates, and identify ST156 as a globally prevalent lineage. We emphasized the necessity of intensified surveillance to track the dissemination of blaNDM-9-carrying CREC.IMPORTANCEThis study provides the first integrative geographic and genomic epidemiology analysis of blaNDM-9-carrying carbapenem-resistant Escherichia coli (CREC). Our 7-year surveillance and genomic analysis revealed critical insights into the genetic characteristics and transmission dynamics of CREC carrying blaNDM-9. The identification of mobile genetic elements, such as IS26 and ISCR1, underscores their role in the horizontal transfer of resistance genes, facilitating the spread of blaNDM-9. Furthermore, given the high frequency of blaNDM-9-carrying CREC in China and its likelihood of spreading clonally in hospitals, there is an immediate need to intensify surveillance efforts. Adopting a One Health perspective, our study highlights the interconnected antimicrobial resistance risks spanning human, animal, and environmental health domains, advocating for strengthened global phylogeographic and phylogenetic surveillance alongside clinical interventions to curb the spread of these high-risk epidemic clones.

Although most Escherichia coli (E. coli) strains are commensal and abundant, certain pathogenic strains cause severe diseases from gastroenteritis to extraintestinal infections. Extraintestinal pathogenic E. coli (ExPEC) contains newborn meningitis E. coli (NMEC), uropathogenic E. coli (UPEC), avian pathogenic E. coli (APEC), and septicemic E. coli (SEPEC) based on their original host and clinical symptom. APEC is a heterogeneous group derived from human ExPEC. APEC causes severe respiratory and systemic diseases in a variety of avians, threatening the poultry industries, food security, and avian welfare worldwide. APEC has many serotypes, and it is a widespread pathogenic bacterium in poultry. In addition, ExPEC strains share significant genetic similarities and similar pathogenic mechanisms, indicating that APEC potentially serves as a reservoir of virulence and resistance genes for human ExPEC, and the virulence and resistance genes can be transferred to humans through food animals. Due to economic losses, drug resistance, and zoonotic potential, APEC has attracted heightened awareness. Various virulence factors and resistance genes involved in APEC pathogenesis and drug resistance have been identified. Here, we review the characteristics, epidemiology, pathogenic mechanism zoonotic potential, and drug resistance of APEC, and summarize the current status of diagnosis, alternative control measures, and vaccine development, which may help to have a better understanding of the pathogenesis and resistance of APEC, thereby reducing economic losses and preventing the spread of multidrug-resistant APEC to humans.

ABSTRACT: Avian pathogenic Escherichia coli (APEC) strains are isolated from lesions of poultry presenting colibacillosis, which is a disease that causes either systemic or localized clinical signs. Such strains share many characteristics with E. coli strains that cause extra-intestinal illness in humans. There is not a consensus on how to define the APEC pathotype with regard to the presence of virulence traits. On the other hand, in the past few years, five minimal predictors for APEC detection were proposed. The E. coli isolates in this work were tested through polymerase chain reaction (PCR) to the five proposed minimal predictors and cva C. The strains presenting them were categorized as potential APEC. The APEC and non-APEC categories showed high resistance (&gt; 50%) to cephalotin, erythromycin, streptomycin, sulphametoxazol/trimethoprim, ampicillin, and amoxicillin. Potential APEC strains were significantly more resistant to cephalotin (p &lt; 0.05) and neomcycin (p &lt; 0.01) than non-APEC. These latter were significantly more resistant to tetracycline (p &lt; 0.01) than the potential APEC strains. These results demonstrate that feces of poultry present E. coli strains with resistant features, showing or not the potential of causing colibacillosis in poultry. Because APEC and extra-intestinal illness in humans may be similar, these resistant strains are of interest to public health.

Population genomic analysis reveals the emergence of high-risk carbapenem-resistant Escherichia coli among ICU patients in China

Editorial Commentary: Genomic Epidemiology: Revealing Hidden Reservoirs for Klebsiella pneumoniae.

Avian pathogenic Escherichia coli (APEC) causes avian colibacillosis or colibacillosis and is a major endemic disease of poultry worldwide, including in Indonesia. It is characterized by a black proventriculus and can damage other organs, leading to pericarditis, perihepatitis, water sacculitis, mesenteritis, and omphalitis. The APEC strain is one of the six main sub-pathotypes of the extraintestinal pathogenic E. coli (ExPEC) pathotype. The relationship between APEC and infection in humans is questionable. The previous studies have suggested poultry products, including meat and eggs, as a potential source of infection for the transmission of ExPEC disease to humans. Due to the absence of reporting of disease incidents and the lack of literature updates on this disease, it seems as if APEC does not exist in Indonesia. Since bacterial resistance is a growing problem in Indonesia, and globally, the World Health Organization issued a statement regarding the importance of assessing related factors and their control strategies. Antimicrobial resistance, especially multidrug resistance, presents a challenge when treating infectious diseases. In Indonesia, the incidence of resistance to several antimicrobials in cases of avian colibacillosis is high. In addition, avian and human extraintestinal E. coli infections present a potential zoonotic risk. Furthermore, a relationship exists between antibiotic resistance to foodborne bacteria and the occurrence of antibiotic resistance in humans, so the use of antibiotics in the poultry industry must be controlled. Therefore, the One Health strategy should be implemented to prevent the overuse or misuse of antibiotics in the poultry industry. This review aimed to increase awareness of people who are at risk of getting Avian pathogenic Escherichia coli (APEC) from poultry by controlling the spread of APEC by maintaining a clean environment and hygienic personnel in poultry farms.

Campylobacteriosis is a leading foodborne zoonosis worldwide, and is frequently associated with handling and consumption of poultry meat. Various studies indicate that Campylobacter causes a substantial human disease burden in low to middle-income countries, but data regarding the organism’s epidemiology in countries like Kenya are scarce. In sub-Saharan Africa, 3.8 million deaths of children under-5 years of age are reported annually. Of those, 25% are caused by diarrheal diseases, and Campylobacter is one of the most frequently isolated bacteria from diarrheic children. With the growth of urban conglomerates, such as Kenya’s capital, Nairobi, changes in diets, food production systems, and retailing dynamics, it is likely that exposure and susceptibility to this pathogen will change. Therefore, the importance of Campylobacter disease burden in Kenya may increase further. The objectives of this study were: 1) to determine the prevalence of Campylobacter spp. in Nairobi’s small-scale chicken farms and meat retailers, and 2) to identify potential risk factors associated with its presence in those sites. The prevalence data provides the first detailed baseline for this pathogen in the urban Kenyan context. The risk factors provide context-specific insights for disease managers. A cross-sectional study of broiler, indigenous chicken farms, and chicken meat retailers, was conducted in a peri-urban, low to middle-income area (Dagoretti), and a very-low income informal settlement (Kibera) of Nairobi. Chicken faeces were collected using one pair of boot socks per farm, and 3 raw chicken meat samples were purchased per retailer. Samples were cultured for viable Campylobacter spp. using mCCDA, followed by blood agar plates in aerobic/microaerobic conditions for prevalence calculations. A questionnaire-based survey on sanitary, sourcing and selling practices was conducted at each site for risk factor identification using logistic regression analyses. A total of 171 farm premises and 53 retailers were sampled and interviewed. The prevalence results for Campylobacter spp. were between 33 to 44% for broiler and indigenous chicken farms, 60% and 64% for retailers, in Dagoretti and Kibera, respectively. Univariable logistic regression showed an association between Campylobacter spp. presence and the easiness of cleaning the display material used by the retailer. Restricting access to the flock was also associated with the pathogen’s presence. Multivariable logistic regression identified the selling of defrosted meat as a retailer risk factor (OR: 4.69; 95% CI: 1.31–19.97), calling for more investigation of the reported repetitive freezing-thawing processes and cold chain improvement options. At the farm-level, having a pen floor of material not easy to clean was found to increase the risk (OR: 2.31; 95%CI: 1.06–5.37). The relatively high prevalence of Campylobacter spp. across different areas and value chain nodes indicates a clear human exposure risk. The open nature of both small-scale broiler and indigenous chicken production practices with low biosecurity, hygiene and informal transactions, likely plays a role in this. While gradual improvement of farm biosecurity is recommended, risk factors identified suggest that consumer education and enforcement of basic food safety principles at the retailer end of the food continuum represent key targets for risk reduction in informal settings.

Chapter 7 - Escherichia coli as a Pathogen

Carbapenem-resistant Enterobacteriaceae have become widely prevalent globally because of antibiotic misuse and the spread of drug-resistant plasmids, where carbapenem-resistant Escherichia coli (CREC) is one of the most common and prevalent pathogens. Furthermore, E. coli has been identified as a member of normal gut flora and does not cause disease under normal circumstances. However, certain strains of E. coli, due to the expression of virulence genes, can cause severe intestinal and extra-intestinal infections. Therefore, clinically, drug resistance and pathogenic E. coli strains are significantly challenging to treat. In this study, a novel CREC strain DC8855 was isolated from the ascites of a patient with intestinal perforation, identified as a novel sequence type 12531 (ST12531) and an unreported serotype O8:H7. It was revealed that the resistance of ST12531 CREC was predominantly conferred by an IncFII(K) plasmid carrying blaNDM-4. Furthermore, phylogenetic analysis indicated that this is the first discovery of such plasmids in China and the first identification in E. coli. Moreover, regarding virulence, the swimming assays, qRT-PCR, and in vitro intestinal barrier model indicated that DC8855 had significantly higher motility, flagella gene expression, and intestinal epithelial cell barrier migration ability than the other sequence types CREC strains (ST167 and ST410). In conclusion, this study identified novel CREC which was multidrug resistant as well as enteropathogenic and therefore requires continuous monitoring.