Epidemiology of Community-Associated, ESBL-Producing Escherichia coli

性状（由申请方提供）：产超广谱β-内酰胺酶（ESBL）大肠埃希菌已在医疗机构中广泛存在。这些微生物不仅对大多数β-内酰胺类耐药，而且对氟喹诺酮类和氨基糖苷类耐药。ESBL生产者通常被认为是一个局限于医院的问题。然而，世界范围内出现了分离产ESBL E.大肠杆菌感染的病人在社区谁以前没有接触到医疗保健系统。与这种感染相关的ESBL类型被称为CTX-M。目前国外已逐渐认识到产ESBL大肠杆菌的一个特殊克隆。大肠杆菌，由系统发生群B2，血清型O25：H4，多位点序列分型（MLST）谱ST 131和CTX-M-15的生产定义，是大多数社区相关感染的原因。在美国，这个问题的严重程度还没有很好的界定。产ESBL E.大肠杆菌进入社区具有重要的临床意义，因为经验性管理常见感染如复杂的尿路感染可能不再有效。本提案所涉及的具体目标是：1.监测产ESBL大肠埃希菌引起的社区相关感染。大肠杆菌在美国多个地理区域。2.确定社区相关产ESBL大肠杆菌的克隆群。来自美国不同地理区域的大肠杆菌分离株。拟议研究包括临床和微生物学部分。这项临床研究是纯观察性的，将用于确定产ESBL大肠杆菌引起的社区相关感染。大肠杆菌。然后在中心实验室进行药敏试验、ESBL基因PCR和测序、脉冲场凝胶电泳、MLST、ESBL分型、血清分型和质粒分析。本项目的总体目标是获得产ESBL大肠杆菌引起的社区相关感染的哨点临床和微生物学数据。大肠杆菌在美国。这将为建立更广泛的全国监督提供一个平台。公共卫生相关性：产生超广谱β-内酰胺酶（ESBL）的大肠杆菌往往对许多类抗生素具有耐药性。这些多重耐药大肠杆菌菌株的传播。大肠杆菌在社区的传播，可能导致泌尿道感染等常见感染的治疗失败。这项拟议中的研究旨在收集美国各地此类感染发生的数据。

DESCRIPTION (provided by applicant): Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has become widespread in healthcare settings. These organisms are not only resistant to most beta-lactams but also fluoroquinolones and aminoglycosides. ESBL producers have typically been regarded as a problem confined to hospitals. However, reports are emerging worldwide of isolation of ESBL-producing E. coli from patients in the community who previously had no contact to the healthcare system. The ESBL type associated with such infection is known as CTX-M. It is increasing recognized overseas that a particular clone of ESBL-producing E. coli, defined by phylogenetic group B2, serotype O25:H4, multilocus sequence typing (MLST) profile ST131 and production of CTX-M-15, is responsible for the majority of community-associated infections. The extent of this problem in the United States is not well defined. Spread of ESBL-producing E. coli into the community has significant clinical implications in that empiric management of common infections such as complicated urinary tract infection may no longer be effective. The specific aims addressed in this proposal are: 1. to conduct surveillance for community-associated infections caused by ESBL-producing E. coli at multiple geographic areas in the United States. 2. To determine the clonal group of community-associated, ESBL-producing E. coli isolates from different geographic areas in the United States. The proposed study consists of clinical and microbiologic parts. The clinical study is purely observational and will be performed to identify community-associated infections caused by ESBL-producing E. coli at the participating sites. Susceptibility testing, PCR and sequencing of ESBL genes, pulsed-field gel electrophoresis, MLST, phylotyping, serotyping and plasmid analysis will then be performed at the central laboratory. The overarching goal of this project is to obtain sentinel clinical and microbiologic data on community- associated infections caused by ESBL-producing E. coli in the United States. This would provide a platform from which to build more extensive nationwide surveillance. PUBLIC HEALTH RELEVANCE: Escherichia coli that produce extended-spectrum beta-lactamase (ESBL) tend to be resistant to many classes of antibiotics. Spread of these multidrug-resistant strains of E. coli in the community may lead to treatment failures of common infections such as urinary tract infection. The proposed study intends to collect data on the occurrence of such infections across the United States.