Escherichia coli sequence type 131 (ST131) subclone h30 as an emergent multidrug-resistant pathogen among US Veterans

Aylin Colpan, Brian Johnston, Stephen Porter, Connie Clabots, Ruth Anway, Lao Thao, Michael A. Kuskowski, Veronika Tchesnokova, Evgeni V. Sokurenko, James R. Johnson, Bradley L. Allen, Gio J. Baracco, Roger Bedimo, Mary Bessesen, Robert A. Bonomo, Stephen M. Brecher, Sheldon T. Brown, Laila Castellino, Arundhati S. Desai, Fletcher FernauMark A. Fisher, James Fleckenstein, Carol S. Fleming, Narla J. Fries, Virginia L. Kan, Carol A. Kauffman, Stacey Klutts, Michael Ohl, Thomas Russo, Andrea Swiatlo, Edwin Swiatlo

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

Background. Escherichia coli sequence type 131 (ST131), typically fluoroquinolone-resistant (FQ-R) and/or extended-spectrum -lactamase (ESBL)-producing, has emerged globally. We assessed its prevalence and characteristics among US veterans.Methods. In 2011, 595 de-identified E. coli clinical isolates were collected systematically within 3 resistance groups (FQ-susceptible [FQ-S], FQ-R, and ESBL-producing) from 24 nationally distributed Veterans Affairs Medical Centers (VAMCs). ST131 and its H30 subclone were detected by polymerase chain reaction and compared with other E. coli for molecular traits, source, and resistance profiles.Results. ST131 accounted for 78% (184/236) of FQ-R and 64.2% (79/123) of ESBL-producing isolates, but only 7.2% (17/236) of FQ-S isolates (P <. 001). The H30 subclone accounted for ≥95% of FQ-R and ESBL-producing, but only 12.5% of FQ-S, ST131 isolates (P <. 001). By back-calculation, 28% of VAMC E. coli isolates nationally represented ST131. Overall, ST131 varied minimally in prevalence by specimen type, inpatient/outpatient source, or locale; was the most prevalent ST, followed distantly by ST95 and ST12 (13% each); and accounted for ≥40% (-lactams), >50% (trimethoprim-sulfamethoxazole, multidrug), or >70% (ciprofloxacin, gentamicin) of total antimicrobial resistance. FQ-R and ESBL-producing ST131 isolates had higher virulence scores than corresponding non-ST131 isolates. ST131 pulsotypes overlapped extensively among VAMCs.Conclusions. Among US veterans, ST131, primarily its H30 subclone, accounts for most antimicrobial-resistant E. coli and is the dominant E. coli strain overall. Possible contributors include multidrug resistance, extensive virulence gene content, and ongoing transmission. Focused attention to ST131, especially its H30 subclone, could reduce infection-related morbidity, mortality, and costs among veterans.

Original languageEnglish (US)
Pages (from-to)1256-1265
Number of pages10
JournalClinical Infectious Diseases
Volume57
Issue number9
DOIs
StatePublished - Nov 1 2013

Fingerprint

Veterans
Fluoroquinolones
Escherichia coli
Virulence
Sulfamethoxazole Drug Combination Trimethoprim
Multiple Drug Resistance
Ciprofloxacin
Gentamicins
Morbidity
Costs and Cost Analysis
Polymerase Chain Reaction
Mortality
Infection
Genes

Keywords

  • antimicrobial resistance
  • Escherichia coli infections
  • extended-spectrum beta-lactamases
  • ST131
  • veterans

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Escherichia coli sequence type 131 (ST131) subclone h30 as an emergent multidrug-resistant pathogen among US Veterans. / Colpan, Aylin; Johnston, Brian; Porter, Stephen; Clabots, Connie; Anway, Ruth; Thao, Lao; Kuskowski, Michael A.; Tchesnokova, Veronika; Sokurenko, Evgeni V.; Johnson, James R.; Allen, Bradley L.; Baracco, Gio J.; Bedimo, Roger; Bessesen, Mary; Bonomo, Robert A.; Brecher, Stephen M.; Brown, Sheldon T.; Castellino, Laila; Desai, Arundhati S.; Fernau, Fletcher; Fisher, Mark A.; Fleckenstein, James; Fleming, Carol S.; Fries, Narla J.; Kan, Virginia L.; Kauffman, Carol A.; Klutts, Stacey; Ohl, Michael; Russo, Thomas; Swiatlo, Andrea; Swiatlo, Edwin.

In: Clinical Infectious Diseases, Vol. 57, No. 9, 01.11.2013, p. 1256-1265.

Research output: Contribution to journalArticle

Colpan, A, Johnston, B, Porter, S, Clabots, C, Anway, R, Thao, L, Kuskowski, MA, Tchesnokova, V, Sokurenko, EV, Johnson, JR, Allen, BL, Baracco, GJ, Bedimo, R, Bessesen, M, Bonomo, RA, Brecher, SM, Brown, ST, Castellino, L, Desai, AS, Fernau, F, Fisher, MA, Fleckenstein, J, Fleming, CS, Fries, NJ, Kan, VL, Kauffman, CA, Klutts, S, Ohl, M, Russo, T, Swiatlo, A & Swiatlo, E 2013, 'Escherichia coli sequence type 131 (ST131) subclone h30 as an emergent multidrug-resistant pathogen among US Veterans', Clinical Infectious Diseases, vol. 57, no. 9, pp. 1256-1265. https://doi.org/10.1093/cid/cit503
Colpan, Aylin ; Johnston, Brian ; Porter, Stephen ; Clabots, Connie ; Anway, Ruth ; Thao, Lao ; Kuskowski, Michael A. ; Tchesnokova, Veronika ; Sokurenko, Evgeni V. ; Johnson, James R. ; Allen, Bradley L. ; Baracco, Gio J. ; Bedimo, Roger ; Bessesen, Mary ; Bonomo, Robert A. ; Brecher, Stephen M. ; Brown, Sheldon T. ; Castellino, Laila ; Desai, Arundhati S. ; Fernau, Fletcher ; Fisher, Mark A. ; Fleckenstein, James ; Fleming, Carol S. ; Fries, Narla J. ; Kan, Virginia L. ; Kauffman, Carol A. ; Klutts, Stacey ; Ohl, Michael ; Russo, Thomas ; Swiatlo, Andrea ; Swiatlo, Edwin. / Escherichia coli sequence type 131 (ST131) subclone h30 as an emergent multidrug-resistant pathogen among US Veterans. In: Clinical Infectious Diseases. 2013 ; Vol. 57, No. 9. pp. 1256-1265.
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abstract = "Background. Escherichia coli sequence type 131 (ST131), typically fluoroquinolone-resistant (FQ-R) and/or extended-spectrum -lactamase (ESBL)-producing, has emerged globally. We assessed its prevalence and characteristics among US veterans.Methods. In 2011, 595 de-identified E. coli clinical isolates were collected systematically within 3 resistance groups (FQ-susceptible [FQ-S], FQ-R, and ESBL-producing) from 24 nationally distributed Veterans Affairs Medical Centers (VAMCs). ST131 and its H30 subclone were detected by polymerase chain reaction and compared with other E. coli for molecular traits, source, and resistance profiles.Results. ST131 accounted for 78{\%} (184/236) of FQ-R and 64.2{\%} (79/123) of ESBL-producing isolates, but only 7.2{\%} (17/236) of FQ-S isolates (P <. 001). The H30 subclone accounted for ≥95{\%} of FQ-R and ESBL-producing, but only 12.5{\%} of FQ-S, ST131 isolates (P <. 001). By back-calculation, 28{\%} of VAMC E. coli isolates nationally represented ST131. Overall, ST131 varied minimally in prevalence by specimen type, inpatient/outpatient source, or locale; was the most prevalent ST, followed distantly by ST95 and ST12 (13{\%} each); and accounted for ≥40{\%} (-lactams), >50{\%} (trimethoprim-sulfamethoxazole, multidrug), or >70{\%} (ciprofloxacin, gentamicin) of total antimicrobial resistance. FQ-R and ESBL-producing ST131 isolates had higher virulence scores than corresponding non-ST131 isolates. ST131 pulsotypes overlapped extensively among VAMCs.Conclusions. Among US veterans, ST131, primarily its H30 subclone, accounts for most antimicrobial-resistant E. coli and is the dominant E. coli strain overall. Possible contributors include multidrug resistance, extensive virulence gene content, and ongoing transmission. Focused attention to ST131, especially its H30 subclone, could reduce infection-related morbidity, mortality, and costs among veterans.",
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author = "Aylin Colpan and Brian Johnston and Stephen Porter and Connie Clabots and Ruth Anway and Lao Thao and Kuskowski, {Michael A.} and Veronika Tchesnokova and Sokurenko, {Evgeni V.} and Johnson, {James R.} and Allen, {Bradley L.} and Baracco, {Gio J.} and Roger Bedimo and Mary Bessesen and Bonomo, {Robert A.} and Brecher, {Stephen M.} and Brown, {Sheldon T.} and Laila Castellino and Desai, {Arundhati S.} and Fletcher Fernau and Fisher, {Mark A.} and James Fleckenstein and Fleming, {Carol S.} and Fries, {Narla J.} and Kan, {Virginia L.} and Kauffman, {Carol A.} and Stacey Klutts and Michael Ohl and Thomas Russo and Andrea Swiatlo and Edwin Swiatlo",
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TY - JOUR

T1 - Escherichia coli sequence type 131 (ST131) subclone h30 as an emergent multidrug-resistant pathogen among US Veterans

AU - Colpan, Aylin

AU - Johnston, Brian

AU - Porter, Stephen

AU - Clabots, Connie

AU - Anway, Ruth

AU - Thao, Lao

AU - Kuskowski, Michael A.

AU - Tchesnokova, Veronika

AU - Sokurenko, Evgeni V.

AU - Johnson, James R.

AU - Allen, Bradley L.

AU - Baracco, Gio J.

AU - Bedimo, Roger

AU - Bessesen, Mary

AU - Bonomo, Robert A.

AU - Brecher, Stephen M.

AU - Brown, Sheldon T.

AU - Castellino, Laila

AU - Desai, Arundhati S.

AU - Fernau, Fletcher

AU - Fisher, Mark A.

AU - Fleckenstein, James

AU - Fleming, Carol S.

AU - Fries, Narla J.

AU - Kan, Virginia L.

AU - Kauffman, Carol A.

AU - Klutts, Stacey

AU - Ohl, Michael

AU - Russo, Thomas

AU - Swiatlo, Andrea

AU - Swiatlo, Edwin

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Background. Escherichia coli sequence type 131 (ST131), typically fluoroquinolone-resistant (FQ-R) and/or extended-spectrum -lactamase (ESBL)-producing, has emerged globally. We assessed its prevalence and characteristics among US veterans.Methods. In 2011, 595 de-identified E. coli clinical isolates were collected systematically within 3 resistance groups (FQ-susceptible [FQ-S], FQ-R, and ESBL-producing) from 24 nationally distributed Veterans Affairs Medical Centers (VAMCs). ST131 and its H30 subclone were detected by polymerase chain reaction and compared with other E. coli for molecular traits, source, and resistance profiles.Results. ST131 accounted for 78% (184/236) of FQ-R and 64.2% (79/123) of ESBL-producing isolates, but only 7.2% (17/236) of FQ-S isolates (P <. 001). The H30 subclone accounted for ≥95% of FQ-R and ESBL-producing, but only 12.5% of FQ-S, ST131 isolates (P <. 001). By back-calculation, 28% of VAMC E. coli isolates nationally represented ST131. Overall, ST131 varied minimally in prevalence by specimen type, inpatient/outpatient source, or locale; was the most prevalent ST, followed distantly by ST95 and ST12 (13% each); and accounted for ≥40% (-lactams), >50% (trimethoprim-sulfamethoxazole, multidrug), or >70% (ciprofloxacin, gentamicin) of total antimicrobial resistance. FQ-R and ESBL-producing ST131 isolates had higher virulence scores than corresponding non-ST131 isolates. ST131 pulsotypes overlapped extensively among VAMCs.Conclusions. Among US veterans, ST131, primarily its H30 subclone, accounts for most antimicrobial-resistant E. coli and is the dominant E. coli strain overall. Possible contributors include multidrug resistance, extensive virulence gene content, and ongoing transmission. Focused attention to ST131, especially its H30 subclone, could reduce infection-related morbidity, mortality, and costs among veterans.

AB - Background. Escherichia coli sequence type 131 (ST131), typically fluoroquinolone-resistant (FQ-R) and/or extended-spectrum -lactamase (ESBL)-producing, has emerged globally. We assessed its prevalence and characteristics among US veterans.Methods. In 2011, 595 de-identified E. coli clinical isolates were collected systematically within 3 resistance groups (FQ-susceptible [FQ-S], FQ-R, and ESBL-producing) from 24 nationally distributed Veterans Affairs Medical Centers (VAMCs). ST131 and its H30 subclone were detected by polymerase chain reaction and compared with other E. coli for molecular traits, source, and resistance profiles.Results. ST131 accounted for 78% (184/236) of FQ-R and 64.2% (79/123) of ESBL-producing isolates, but only 7.2% (17/236) of FQ-S isolates (P <. 001). The H30 subclone accounted for ≥95% of FQ-R and ESBL-producing, but only 12.5% of FQ-S, ST131 isolates (P <. 001). By back-calculation, 28% of VAMC E. coli isolates nationally represented ST131. Overall, ST131 varied minimally in prevalence by specimen type, inpatient/outpatient source, or locale; was the most prevalent ST, followed distantly by ST95 and ST12 (13% each); and accounted for ≥40% (-lactams), >50% (trimethoprim-sulfamethoxazole, multidrug), or >70% (ciprofloxacin, gentamicin) of total antimicrobial resistance. FQ-R and ESBL-producing ST131 isolates had higher virulence scores than corresponding non-ST131 isolates. ST131 pulsotypes overlapped extensively among VAMCs.Conclusions. Among US veterans, ST131, primarily its H30 subclone, accounts for most antimicrobial-resistant E. coli and is the dominant E. coli strain overall. Possible contributors include multidrug resistance, extensive virulence gene content, and ongoing transmission. Focused attention to ST131, especially its H30 subclone, could reduce infection-related morbidity, mortality, and costs among veterans.

KW - antimicrobial resistance

KW - Escherichia coli infections

KW - extended-spectrum beta-lactamases

KW - ST131

KW - veterans

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DO - 10.1093/cid/cit503

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AN - SCOPUS:84884227009

VL - 57

SP - 1256

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JO - Clinical Infectious Diseases

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