Epidemiology of Community-Associated, ESBL-Producing Escherichia coli

描述(申请人提供)：产超广谱β-内酰胺酶(ESBL)的大肠埃希氏菌在医疗保健机构中已变得普遍。这些细菌不仅对大多数β-内酰胺类抗生素耐药，而且对氟喹诺酮类和氨基糖苷类药物也有抗药性。ESBL生产商通常被视为仅限于医院的问题。然而，世界各地都有报告说，从社区中以前没有接触过医疗系统的患者中分离出产生ESBL的大肠埃希菌。与这种感染相关的ESBL型被称为CTX-M。国外越来越多的人认识到，产超广谱β-内酰胺酶大肠杆菌的一个特定克隆，由系统发育群B2，O25：H4血清型，多位点序列分型(MLST)谱ST131和CTX-M-15的产生，是大多数社区相关感染的原因。这个问题在美国的严重程度没有得到很好的界定。产超广谱β-内酰胺酶的大肠埃希菌在社区的传播具有重大的临床意义，因为对常见感染的经验性治疗可能不再有效，例如复杂的尿路感染。这项提案涉及的具体目标是：1.在美国多个地理区域对产超广谱β-内酰胺酶的大肠杆菌引起的社区相关感染进行监测。2.确定美国不同地理区域产超广谱β-内酰胺酶(ESBL)菌株的克隆群。这项拟议的研究包括临床和微生物学部分。这项临床研究纯粹是观察性的，将进行以确定由产超广谱β-内酰胺酶的大肠杆菌在参与地点引起的社区相关感染。然后将在中心实验室进行药敏试验、ESBL基因的聚合酶链式反应和测序、脉冲场凝胶电泳法、MLST、系统分型、血清分型和质粒分析。该项目的首要目标是获得美国产超广谱β-内酰胺酶大肠杆菌引起的社区相关感染的前哨临床和微生物学数据。这将提供一个平台，以便在全国范围内建立更广泛的监控。与公共卫生相关：产生超广谱β-内酰胺酶(ESBL)的大肠埃希菌往往对多种抗生素具有耐药性。这些耐多药的大肠杆菌菌株在社区中的传播可能会导致尿路感染等常见感染的治疗失败。这项拟议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.