Escherichia coli Sequence Type 131 Is a Dominant, Antimicrobial-Resistant Clonal Group Associated with Healthcare and Elderly Hosts
Escherichia coli Sequence Type 131 Is a Dominant, Antimicrobial-Resistant Clonal Group Associated with Healthcare and Elderly Hosts
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DOI：
10.1086/669865
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发表时间：
2013-04-01
影响因子：
4.5
通讯作者：
Johnson, James R.
中科院分区：
文献类型：
--
作者：
Banerjee, Ritu;Johnston, Brian;Johnson, James R.
OBJECTIVE.确定ST 131序列型大肠杆菌感染的患病率、预测因子和结局。回溯队列设置。明尼苏达州奥姆斯特德县的所有医疗机构（例如，社区医院、三级护理中心、长期护理机构和门诊诊所）。门诊和住院的儿童和成人肠外大肠杆菌。大肠杆菌分离株.我们分析了299个连续的，非重复的肠外E。2011年2月和3月提交给奥姆斯特德县实验室的大肠杆菌分离株。ST 131采用单核苷酸多态性聚合酶链反应进行鉴定，并通过脉冲场凝胶电泳进行进一步评价。相关的临床数据通过病历回顾进行提取。大多数分离株来自尿液标本（90%）、门诊患者（68%）和社区相关感染（61%）。ST 131占总体分离株的27%，并且占对氟喹诺酮类（81%）、甲氧苄啶-磺胺甲恶唑（42%）、庆大霉素（79%）和头孢曲松（50%）耐药的分离株的较大比例。ST 131的流行率随着年龄的增长而增加（占11-20岁年龄段分离株的5%，占51-60岁年龄段分离株的26%，占91-100岁年龄段分离株的50%）。ST 131占医疗相关分离株（49%）的比例高于社区相关分离株（15%），占E.长期护理设施（LTCF）居民的大肠杆菌分离株。ST 131携带的多变量预测因素包括年龄较大、LTCF居住、既往尿路感染、高复杂性感染和既往使用氟喹诺酮类、大环内酯类和超广谱头孢菌素类。经多变量校正后，ST 131相关感染结局包括接受1种以上抗生素（比值比[OR]，2.54 [95%置信区间（CI），1.25-5.17]）和持续或复发症状（OR，2.53 [95% CI，1.08-5.96]）。两种全球主要的ST 131脉型占ST 131分离株的45%。ST 131是一种占主导地位的耐药性克隆组，与医疗环境、老年宿主和持续或复发症状相关。感染控制医院流行病学2013;34（4）：361-369
OBJECTIVE. To determine prevalence, predictors, and outcomes of infection due to Escherichia coli sequence type ST131.DESIGN. Retrospective cohort.SETTING. All healthcare settings in Olmsted County, Minnesota (eg, community hospital, tertiary care center, long-term care facilities, and ambulatory clinics).PATIENTS. Ambulatory and hospitalized children and adults with extraintestinal E. coli isolates.METHODS. We analyzed 299 consecutive, nonduplicate extraintestinal E. coli isolates submitted to Olmsted County laboratories in February and March 2011. ST131 was identified using single-nucleotide polymorphism polymerase chain reaction and further evaluated through pulsed-field gel electrophoresis. Associated clinical data were abstracted through medical record review.RESULTS. Most isolates were from urine specimens (90%), outpatients (68%), and community-associated infections (61%). ST131 accounted for 27% of isolates overall and for a larger proportion of those isolates resistant to fluoroquinolones (81%), trimethoprim-sulfamethoxazole (42%), gentamicin (79%), and ceftriaxone (50%). The prevalence of ST131 increased with age (accounting for 5% of isolates from those 11-20 years of age, 26% of isolates from those 51-60 years of age, and 50% of isolates from those 91-100 years of age). ST131 accounted for a greater proportion of healthcare-associated isolates (49%) than community-associated isolates (15%) and for fully 76% of E. coli isolates from long-term care facility (LTCF) residents. Multivariable predictors of ST131 carriage included older age, LTCF residence, previous urinary tract infection, high-complexity infection, and previous use of fluoroquinolones, macrolides, and extendedspectrum cephalosporins. With multivariable adjustment, ST131-associated infection outcomes included receipt of more than 1 antibiotic (odds ratio [OR], 2.54 [95% confidence interval (CI), 1.25-5.17]) and persistent or recurrent symptoms (OR, 2.53 [95% CI, 1.08-5.96]). Two globally predominant ST131 pulsotypes accounted for 45% of ST131 isolates.CONCLUSIONS. ST131 is a dominant, antimicrobial-resistant clonal group associated with healthcare settings, elderly hosts, and persistent or recurrent symptoms. Infect Control Hosp Epidemiol 2013;34(4):361-369