Emergence of clonal groups O1:HNM-D-ST59, O15:H1-D-ST393, O20:H34/HNM-D-ST354, O25b:H4-B2-ST131 and ONT:H21,42-B1-ST101 among CTX-M-14-producing Escherichia coli clinical isolates in Galicia, northwest Spain

doi:10.1016/j.ijantimicag.2010.09.012

International Journal of Antimicrobial Agents

Volume 37, Issue 1, January 2011, Pages 16-21

https://doi.org/10.1016/j.ijantimicag.2010.09.012 Get rights and content

Abstract

CTX-M enzymes, mainly CTX-M-14 and CTX-M-15, have emerged as the most prevalent extended-spectrum β-lactamase (ESBL) type produced by Escherichia coli in Spain, with successful dissemination of clonal group O25b:H4-B2-ST131 producing CTX-M-15 within the hospital and community settings. However, until now CTX-M-14-producing E. coli in Spain had been shown to belong to a wide variety of serotypes with no predominance of a certain clonal group. In the present study, 654 E. coli strains positive for ESBL production obtained between 2005 and 2008 from inpatients and outpatients of four hospitals in Galicia, northwest Spain, were analysed. The strains were characterised with regard to ESBL enzymes, serotype, virulence genes, phylogenetic group, multilocus sequence type, and pulsed-field gel electrophoresis of XbaI-digested DNA. As a result, the emergence of certain clonal groups of extraintestinal pathogenic E. coli producing CTX-M-14 has been detected in this geographic area, including O1:HNM-D-ST59, O15:H1-D-ST393/ST1394, O20:H34/HNM-D-ST354, O25b:H4-B2-ST131 and ONT:H21,42-B1-ST101. These five clonal groups showed a high virulence potential as they harboured more than eight virulence factors, which could explain their successful dissemination.

Introduction

CTX-M β-lactamases were first reported from Japan in 1986 [1]. During the 1990s, general dissemination and occasional outbreaks by CTX-M-producing Enterobacteriaceae occurred [2]. Since the year 2000, however, Escherichia coli producing CTX-M β-lactamases have emerged worldwide as an important cause of community urinary tract infections (UTIs), a phenomenon known as ‘the CTX-M pandemic’ [3]. Clonal dissemination of CTX-M-15-producing E. coli belonging to phylogenetic group B2 and sequence type ST131 has been reported in different countries, including Spain [4], [5], [6], [7]. In previous studies, we have shown that the most prevalent extended-spectrum β-lactamase (ESBL) types produced by E. coli isolates in the Lugo health area, northwest Spain, are CTX-M, primarily CTX-M-14 and CTX-M-15, with successful dissemination of clonal group O25b:H4-B2-ST131 producing CTX-M-15 within the hospital and community [4]. However, since its first detection in Spain [8] CTX-M-14-producing E. coli have been shown to belong to a wide variety of serotypes, with no predominance of a certain clonal group [4], [9]. In the present study, we describe the detailed characterisation of five CTX-M-14-producing clonal groups of E. coli that have emerged in this health region in Galicia, northwest Spain.

Section snippets

Bacterial strains

The present study included 654 E. coli strains detected as being positive for ESBL production in the Microbiology Unit of four hospitals in Galicia, namely Complexo Hospitalario Xeral-Calde, Lugo (325 strains), Complexo Hospitalario Universitario A Coruña (150 strains), Complexo Hospitalario de Ourense (100 strains) and Complexo Hospitalario Arquitecto Marcide-Prof. Novoa Santos, Ferrol (79 strains). The strains included in the present study (one strain per patient) were obtained from 2005 to

Results

All 654 strains were characterised with regard to serotype and ESBL type. CTX-M-14 (334 strains; 51.1%) and CTX-M-15 (119 strains; 18.2%) were the most prevalent ESBL enzymes detected. Among CTX-M-15-producing strains, 103/119 (86.6%) belonged to clonal group O25b:H4-B2-ST131, which also produced other ESBL types (CTX-M-1, CTX-M-9, CTX-M-14 and CTX-M-32) in 10 strains.

In contrast to CTX-M-15, CTX-M-14-producing strains belonged to a wide number of serotypes. Those CTX-M-14-producing strains

Discussion

In previous studies, we have shown that CTX-M enzymes, mainly CTX-M-14 and CTX-M-15, are currently the most prevalent ESBL types produced by E. coli isolates in the Xeral-Calde Hospital of Lugo, with 57.1% producing CTX-M-14 and 21.9% producing CTX-M-15 among 105 ESBL-producing E. coli isolated from January 2006 to March 2007 [4]. We also reported the successful dissemination of clone O25b:H4-ST131 producing CTX-M-15 within the hospital and community, including across national boundaries [4],

Conclusion

The emergence of multidrug-resistant virulent clonal groups of E. coli that may be spreading rapidly in the community poses a significant public health threat. This has been detected in this health area in northwest of Spain, since certain CTX-M-14-producing E. coli clones are presently emerging and some of them are already known as clonal groups of clinical importance (such as O1:HNM-D-ST59, O15:H1-D-ST393 and O25b:H4-B2-ST131). We now report important new significance of CTX-M-14-producing

Acknowledgments

The authors thank Monserrat Lamela and Angeles Espiño for skilful technical assistance. AM acknowledges the Ramón y Cajal programme from the Spanish Ministerio de Ciencia e Innovación. RM acknowledges the grant from the Agencia Española de Cooperación Internacional (AECI) from the Spanish Ministerio de Asuntos Exteriores y Cooperación.

Funding: This work was partially supported by grants PI020918, REIPI RD06/0008/1018-0025-1016, PS09/01273, PI081368 and PS09/00687 (Instituto de Salud Carlos III

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Emergence of clonal groups O1:HNM-D-ST59, O15:H1-D-ST393, O20:H34/HNM-D-ST354, O25b:H4-B2-ST131 and ONT:H21,42-B1-ST101 among CTX-M-14-producing Escherichia coli clinical isolates in Galicia, northwest Spain

Abstract

Introduction

Section snippets

Bacterial strains

Results

Discussion

Conclusion

Acknowledgments

Curr Opin Microbiol

Int J Antimicrob Agents

Diagn Microbiol Infect Dis

Diagn Microbiol Infect Dis

Lancet

Int J Antimicrob Agents

J Infect

Novel plasmid-mediated β-lactamase from Escherichia coli that inactivates oxyimino-cephalosporins

Antimicrob Agents Chemother

Concurrent outbreaks of extended-spectrum β-lactamase-producing organisms of the family Enterobacteriaceae in a Warsaw hospital

J Antimicrob Chemother

Molecular epidemiology of Escherichia coli producing extended-spectrum β-lactamases in Lugo (Spain): dissemination of clone O25b:H4-ST131 producing CTX-M-15

J Antimicrob Chemother

Dissemination of clonally related Escherichia coli strains expressing extended-spectrum β-lactamase CTX-M-15

Emerg Infect Dis

Intercontinental emergence of Escherichia coli clone O25:H4-ST131 producing CTX-M-15

J Antimicrob Chemother

Spread of Escherichia coli strains with high-level cefotaxime and ceftazidime resistance between the community, long-term care facilities, and hospital institutions

J Clin Microbiol

Identification and broad dissemination of the CTX-M-14 β-lactamase in different Escherichia coli strains in the northwest area of Spain

J Clin Microbiol

Extended broad-spectrum β-lactamases conferring transferable resistance to newer β-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns

Rev Infect Dis