1. Genetic Predictive Factors for Nonsusceptible Phenotypes and Multidrug Resistance in Expanded-Spectrum Cephalosporin-Resistant Uropathogenic Escherichia coli from a Multicenter Cohort: Insights into the Phenotypic and Genetic Basis of Coresistance
- Author
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Nicole Jackson, Cheyenne R. Belmont, Nicole J. Tarlton, Yuan Hu Allegretti, Sheila Adams-Sapper, Yolanda Yue Huang, Clarissa A. Borges, Bradley W. Frazee, Danka Florence-Petrovic, Clarisse Hufana, Anna Parker, Claire F. Mastrangelo, Shevya Awasthi, Isha Kane, Zlatan Coralic, Steve Miller, Joycelyn Diaz, Christopher Fee, Cassiana E. Bittencourt, Omai Garner, Sukantha Chandrasekaran, Claudia Crandall, Julian C. Marcha, Mir H. Noorbakhsh, Patricia Rodrigues-Wong, Tara R. deBoer, Lee W. Riley, and Lutgring, Joseph Daniel
- Subjects
Urologic Diseases ,Drug Resistance ,uropathogenic E.coil ,whole-genome sequence ,Medical and Health Sciences ,Microbiology ,beta-Lactamases ,expanded-spectrum cephalosporin resistance ,Vaccine Related ,Clinical Research ,Biodefense ,Genetics ,Humans ,Uropathogenic Escherichia coli ,Molecular Biology ,Escherichia coli Infections ,Prevention ,Bacterial ,multilocus sequence type ,uropathogenic E. coli ,Biological Sciences ,Cephalosporins ,Phenotype ,Emerging Infectious Diseases ,Infectious Diseases ,Good Health and Well Being ,ESBL ,Antimicrobial Resistance ,Infection ,Multiple ,Monobactams - Abstract
Antimicrobial resistance in urinary tract infections (UTIs) is a major public health concern. This study aims to characterize the phenotypic and genetic basis of multidrug resistance (MDR) among expanded-spectrum cephalosporin-resistant (ESCR) uropathogenic Escherichia coli (UPEC) causing UTIs in California patient populations. Between February and October 2019, 577 ESCR UPEC isolates were collected from patients at 6 clinical laboratory sites across California. Lineage and antibiotic resistance genes were determined by analysis of whole-genome sequence data. The lineages ST131, ST1193, ST648, and ST69 were predominant, representing 46%, 5.5%, 4.5%, and 4.5% of the collection, respectively. Overall, 527 (91%) isolates had an expanded-spectrum β-lactamase (ESBL) phenotype, with blaCTX-M-15, blaCTX-M-27, blaCTX-M-55, and blaCTX-M-14 being the most prevalent ESBL genes. In the 50 non-ESBL phenotype isolates, 40 (62%) contained blaCMY-2, which was the predominant plasmid-mediated AmpC (pAmpC) gene. Narrow-spectrum β-lactamases, blaTEM-1B and blaOXA-1, were also found in 44.9% and 32.1% of isolates, respectively. Among ESCR UPEC isolates, isolates with an ESBL phenotype had a 1.7-times-greater likelihood of being MDR than non-ESBL phenotype isolates (P < 0.001). The cooccurrence of blaCTX-M-15, blaOXA-1, and aac(6')-Ib-cr within ESCR UPEC isolates was strongly correlated. Cooccurrence of blaCTX-M-15, blaOXA-1, and aac(6')-Ib-cr was associated with an increased risk of nonsusceptibility to piperacillin-tazobactam, cefepime, fluoroquinolones, and amikacin as well as MDR. Multivariate regression revealed the presence of blaCTX-M-55, blaTEM-1B, and the ST131 genotype as predictors of MDR. IMPORTANCE The rising incidence of resistance to expanded-spectrum cephalosporins among Escherichia coli strains, the most common cause of UTIs, is threatening our ability to successfully empirically treat these infections. ESCR E. coli strains are often MDR; therefore, UTI caused by these organisms often leads to treatment failure, increased length of hospital stay, and severe complications (D. G. Mark, Y.-Y. Hung, Z. Salim, N. J. Tarlton, et al., Ann Emerg Med 78:357-369, 2021, https://doi.org/10.1016/j.annemergmed.2021.01.003). Here, we performed an in-depth analysis of genetic factors of ESCR E. coli associated with coresistance and MDR. Such knowledge is critical to advance UTI diagnosis, treatment, and antibiotic stewardship.
- Published
- 2022