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The emergence and dissemination of CTX-M-producing Escherichia coli sequence type 131 causing community-onset bacteremia in Israel

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Abstract

Community-onset bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC-COBSIs) were investigated over a 7-year-period (2003–2009) in our institution. ESBL-EC-COBSI inclusion criteria were cefotaxime/ceftazidime non-susceptible blood isolates recovered during 48 h upon hospital admission. Forty-one isolates were molecularly characterized. Susceptibilities were determined (Vitek-2) and genotyping was performed [multilocus sequence typing (MLST)]. CTX-M genes were determined [polymerase chain reaction (PCR) and sequencing] and bla CTX-M-encoding plasmids (n = 10) were analyzed and compared. Phylogrouping and virulence genes were identified (PCR). The incidence rate of ESBL-EC-COBSIs has increased from 2.94 to 7.87 cases/10,000 admissions. All isolates were multidrug-resistant (MDR), displaying co-resistance to ciprofloxacin (93 %), trimethoprim–sulfamethoxazole (85 %), and gentamicin (51 %). MLST identified ten sequence types (STs), of which five were novel. ST131 accounted for 66 % of the cases (27/41), and dominated over the years (prevalence of 25 % in 2003 and 85 % in 2009). All isolates carried CTX-M genes with the following prevalence: bla CTX-M-2 (6/8; 75 %) in 2003; bla CTX-M-15 (9/13, 69 % in 2007); and bla CTX-M-15 (11/20, 55 %) and bla CTX-M-14 (7/20, 35 %) in 2009. bla CTX-M-15- and bla CTX-M-14-encoding plasmids harbored by ST131 differed. Of all isolates, 98 % belonged to virulent phylogroups B2 (28/41, 68 %) and D (12/41, 29 %), though ST131 isolates carried a higher number of virulence genes compared to other lineages (p < 0.05). The incidence of ESBL-EC-COBSIs increased 2.7-fold during the period 2003–2009. This increase appears to be related to the emergence and clonal expansion of bla CTX-M-15- or bla CTX-M-14-carrying ST131. The superiority of this virulent lineage should be further explored.

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Acknowledgments

We would like to thank the platform Genotyping of Pathogens and Public Health (Institut Pasteur) for the coding of all novel MLST alleles and profiles.

This work was performed in partial fulfillment of the requirements for an M.Sc. degree of Daphne Karfunkel, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Molecular Epidemiology and Antimicrobial Resistance Laboratory, Division of Epidemiology, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, 64239, Israel

    D. Karfunkel, Y. Carmeli, I. Chmelnitsky, T. Kotlovsky & S. Navon-Venezia

  2. Department of Molecular Biology, Ariel University Center of Samaria, Ariel, Israel

    S. Navon-Venezia

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  1. D. Karfunkel
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  2. Y. Carmeli
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  3. I. Chmelnitsky
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  4. T. Kotlovsky
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  5. S. Navon-Venezia
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Correspondence to S. Navon-Venezia.

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Karfunkel, D., Carmeli, Y., Chmelnitsky, I. et al. The emergence and dissemination of CTX-M-producing Escherichia coli sequence type 131 causing community-onset bacteremia in Israel. Eur J Clin Microbiol Infect Dis 32, 513–521 (2013). https://doi.org/10.1007/s10096-012-1765-9

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  • DOI: https://doi.org/10.1007/s10096-012-1765-9

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