Abstract
Sequence type (ST) 131 is a multidrug-resistant pandemic lineage of E. coli responsible for extraintestinal infections. Few surveillance data of ST131 included all antimicrobial-susceptible and -resistant isolates or focused on community-acquired urinary tract infection (UTI). From a population-based surveillance pool of 2997 outpatient urine E. coli isolates, 542 were selected for detection of ST131 based on ciprofloxacin and/or cefotaxime resistance. Pulsed-field gel electrophoresis (PFGE) was performed on all ST131 isolates to further determine their relatedness. The estimated overall ST131 prevalence in this community UTI cohort increased from 11.2% (in 2002–2004), 12.2% (in 2006–2008), 13.6% (in 2010–2012), to 17.4% in 2014–2016 (p < 0.01). In the ciprofloxacin-resistant/cefotaxime-resistant group, ST131 increased from 33.3% in 2002–2004 to 72.1% in 2014–2016 (p < 0.01). In the ciprofloxacin-resistant/cefotaxime-susceptible group, ST131 was found in 24.3% overall without significant increase in its prevalence over time. PFGE showed emergence of a cluster of ciprofloxacin-resistant/cefotaxime-resistant ST131 carrying Gr. 1 CTX-M ESBL in 2014–2016, especially 2016. Multivariate analysis revealed that age (≥65 y.o) and ciprofloxacin resistance were independent factors associated with ST131. This longitudinal surveillance showed that ciprofloxacin-resistant/cefotaxime-susceptible ST131 has been circulating in the community since 2002 but ciprofloxacin-resistant/cefotaxime-resistant ST131 increased rapidly in the later years.
Highlights
Escherichia coli is the most common cause of community-acquired urinary tract infections (UTI) [1]
A total of 2997 outpatient urine E. coli isolates were in the Taiwan Surveillance of Antimicrobial Resistance (TSAR) biennial collection from 2002 to 2016 with over 600 isolates in each study period
When we grouped our isolates based on their co-resistance to fluoroquinolones (FQ), ciprofloxacin (CIP), and extended-spectrum cephalosporin (ESC) cefotaxime (CTX), we found a significant increase of CIP-R/CTX-R isolates, from 4.8% in 2002–2004, to 15.1%
Summary
Escherichia coli is the most common cause of community-acquired urinary tract infections (UTI) [1]. There has been an increase of extended-spectrum β-lactamase (ESBL)-producing and fluoroquinolone-resistant E. coli in community infections in many areas including Europe, America, and Asia. E coli bacteriuria nearly doubled from 2005 to 2009 among elderly patients and those with community-associated isolates in a population-based study in the USA [2]. Microorganisms 2021, 9, 963 longitudinal study in Spain (1999–2010), the proportion of E. coli isolates resistant to thirdgeneration cephalosporins and fluoroquinolones increased significantly In an earlier report from our Taiwan Surveillance of Antimicrobial Resistance (TSAR) program on E. coli from outpatients, the proportion of isolates non-susceptible to fluoroquinolone and the prevalence of ESBL-producers increased from 15.0% and 4% in 2002 to 26.9% and 11.7% in 2012, respectively, with the ESBL being most (96.3%) due to CTX-M type [4]. The emergence of E. coli strains resistant to extended-spectrum cephalosporins and fluoroquinolones is a public health threat in both developed and developing countries [5]
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