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Escherichia coli sequence type 131 (ST131) subclone H30 as an emergent multidrug-resistant pathogen among US veterans

Aylin Colpan1, Brian Johnston, Stephen Porter

  • 1University of Minnesota, Minneapolis.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|August 9, 2013
PubMed
Abstract

Insights

Escherichia coli ST131 is the dominant strain among US veterans, driving most antimicrobial resistance. Focused attention on ST131, particularly the H30 subclone, can reduce infections and healthcare costs.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Public Health

Background:

  • Escherichia coli sequence type 131 (ST131) is a globally emerging pathogen.
  • ST131 is frequently resistant to fluoroquinolones (FQ-R) and/or produces extended-spectrum β-lactamases (ESBL).
  • The prevalence and characteristics of ST131 among US veterans were unknown.

Purpose of the Study:

  • To assess the prevalence and characteristics of Escherichia coli ST131 among US veterans.
  • To determine the proportion of antimicrobial resistance attributable to ST131.
  • To compare the virulence of ST131 isolates with other E. coli strains.

Main Methods:

  • Systematic collection of 595 E. coli clinical isolates from 24 Veterans Affairs Medical Centers in 2011.
  • Categorization of isolates into fluoroquinolone-susceptible (FQ-S), FQ-resistant (FQ-R), and ESBL-producing groups.
  • Detection of ST131 and its H30 subclone using polymerase chain reaction; comparison of molecular traits, source, and resistance profiles.

Main Results:

  • ST131 accounted for 78% of FQ-R and 64.2% of ESBL-producing E. coli isolates.
  • The H30 subclone comprised over 95% of FQ-R and ESBL-producing ST131 isolates.
  • ST131 was the most prevalent E. coli strain overall, contributing significantly to antimicrobial resistance, particularly to ciprofloxacin and gentamicin.

Conclusions:

  • Escherichia coli ST131, predominantly the H30 subclone, is the dominant E. coli strain among US veterans.
  • ST131 is associated with multidrug resistance, high virulence gene content, and ongoing transmission.
  • Targeting ST131 could decrease infection-related morbidity, mortality, and costs in the veteran population.
Keywords:
Escherichia coli infectionsST131antimicrobial resistanceextended-spectrum beta-lactamasesveterans

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