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Escherichia coli Sequence Type 131 Is a Dominant, Antimicrobial-Resistant Clonal Group Associated with Healthcare and Elderly Hosts

  • Ritu Banerjee (a1), Brian Johnston (a2), Christine Lohse (a3), Stephen B. Porter (a2), Connie Clabots (a2) and James R. Johnson (a2)...



To determine prevalence, predictors, and outcomes of infection due to Escherichia coli sequence type ST131.


Retrospective cohort.


All healthcare settings in Olmsted County, Minnesota (eg, community hospital, tertiary care center, long-term care facilities, and ambulatory clinics).


Ambulatory and hospitalized children and adults with extraintestinal E. coli isolates.


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.


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 extended-spectrum 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 STB 1 isolates.


ST131isa dominant, antimicrobial-resistant clonal group associated with healthcare settings, elderly hosts, and persistent or recurrent symptoms.


Corresponding author

Division of Pediatric Infectious Diseases, 200 First Street SW, Rochester, MN 55905 (


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1.Coque, T, Baquero, F, Canton, R. Increasing prevalence of ESBL-producing enterobacteriaceae in Europe. Eurosurveillance 2008;13:111.
2.Nicolas-Chanoine, M-H, Blanco, J, Leflon-Guibout, V, et al.Intercontinental emergence of Escherichia coli clone O25:H4ST131 producing CTX-M-15. J Antimicrob Chemother 2008;61:273281.
3.Peirano, G, Pitout, J. Molecular epidemiology of Escherichia coli producing CTX-M-beta lactamases: the wordwide emergence of clone ST131 025:H4 Int J Antimicrob Agents 2009;35:316321.
4.Johnson, J, Johnston, B, Clabots, C, Kuskowski, M, Castanheira, M. Escherichia coli sequence type ST131 as the major cause of serious multidrug-resistant E. coli infections in the United States. Clin Infect Dis 2010;51:286294.
5.Yokota, S, Sato, T, Okubo, T, et al.Prevalence of fluoroquinolone-resistant Escherichia coli 025:H4-ST131 (CTX-M-15-nonproducing) strains isolated in Japan. Chemother 2012;58:5259.
6.Rogers, B, Sidjabat, H, Paterson, D. Escherichia coli 025b-ST131: a pandemic, multiresistant, community-associated strain. J Antimicrob Chemother 2011;66:114.
7.Cagnacci, S, Gualco, L, Debbia, E, Schito, G, Marchese, A. European emergence of ciprofloxacin-resistant Escherichia coli clonal groups O25:H4-ST131 and O15:K52:H1 causing community-acquired uncomplicated cystitis. J Clin Microbiol 2008;46:26052612.
8.Livermore, D, Canton, R, Gniadkowski, M, et al.CTX-M: changing the face of ESBLs in Europe. J Antimicrob Chemother 2007;59:165174.
9.Johnson, J, Urban, C, Weissman, S, et al.Molecular epidemiological analysis of Escherichia coli sequence type ST131 (O25:H4) and blaCTX-M-15 among extended spectrum beta-lactamase producing E. coli from the United States, 2000–2009. Antimicrob Agents Chemother 2012;56:23642370.
10.Johnson, J, Nicolas-Chanoine, M-H, DebRoy, C, et al.Comparison of Escherichia coli ST131 pulsotypes, by epidemiologic traits, 1967–2009. Emerg Infect Dis 2012;18:598607.
11.Owens, R, Johnson, J, Stogsdill, P, Yarmus, L, Lolans, K, Quinn, J. Community transmission in the United States of a CTX-M-15-producing sequence type ST 131 Escherichia coli strain resulting in death. J Clin Microbiol 2011;49:34063408.
12.Vincent, C, Boerlin, P, Daignault, D, et al.Food reservoir for Escherichia coli causing urinary tract infections. Emerg Infect Dis 2010;16:8895.
13.Swami, S, Liesinger, J, Shah, N, Baddour, L, Banerjee, R. Incidence of antibiotic-resistant Escherichia coli bacteriuria according to age and location of onset: a population-based study from Olmsted County, Minnesota. Mayo Clin Proc 2012;87:753759.
14.Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Nineteenth Informational Supplement. CLSI document (M100-S19). Wayne, PA: Clinical and Laboratory Standards Institute, 2009.
15.Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Twentieth Informational Supplement. CLSI document M100-S20. Wayne, PA: Clinical and Laboratory Standards Institute, 2010.
16.Clermont, O, Bonacorsi, S, Bingen, E. Rapid and simple determination of Escherichia coli phylogenetic group. Appl Environ Microbiol 2000;66:45554558.
17.Johnson, J, Menard, M, Johnston, B, Kuskowski, M, Nichol, K, Zhanel, G. Epidemic clonal groups of Escherichia coli as a cause of antimicrobial-resistant urinary tract infections in Canada, 2002–2004. Antimicrob Agents Chemother 2009;53:27332739.
18.Weissman, S, Johnson, J, Tchesnokova, V, et al.High resolution two-locus clonal typing of extraintestinal pathogenic Escherichia coli. Appl Environ Microbiol 2012;78:13531360.
19.Chung, H-C, Lai, C-H, Lin, J-N, et al.Bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli sequence type ST131 and non-ST131 clones: comparison of demographic data, clinical features, and mortality. Antimicrob Agents Chemother 2012;56:618622.
20.Tiruvury, H, Johnson, J, Mariano, N, et al.Identification of CTX-M-beta-lactamases among Escherichia coli from the community in New York City. Diag Microbiol Infect Dis 2012;72:248252.
21.Blanco, M, Alonso, MP, Nicolas-Chanoine, M-H, et al.Molecular epidemiology of Escherichia coli producing extended-spectrum beta lactamases in Lugo (Spain): dissemination of clone O25b: H4-ST131 producing CTX-M-15. J Antimicrob Chemother 2009;63:11351141.
22.Brisse, S, Diancourt, L, Laouenan, C, et al.Phylogenetic distribution of CTX-M and non-ESBL producing Escherichia coli isolates: group B2 isolates, except ST131 rarely produce CTX-M enzymes. J Clin Microbiol 2012;50:29742981.
23.Burke, L, Humphreys, H, Fitzgerald-Hughes, D. The revolving door between hospital and community: extended-spectrum β-lactamase-producing Escherichia coli in Dublin. J Hosp Infect 2012;81:192198.
24.Urban, C, Mariano, N, Bradford, PA, et al.Identification of CTX-M-β-lactamases in Escherichia coli from hospitalized patients and residents of long-term care facilities. Diag Microbiol Infect Dis 2010;66:402406.
25.Rooney, P, O'Leary, M, Loughrey, A, et al.Nursing homes as a reservoir of extended-spectrum β-lactamase (ESBL)-producing ciprofloxacin-resistant Escherichia coli. J Antimicrob Chemother 2009;64:635641.
26.March, A, Aschbacher, R, Dhanji, H, et al.Colonization of residents and staff of a long term care facility and adjacent acute-care hospital geriatric unit by multiresistant bacteria. Clin Microbiol Infect 2009;16:934944.
27.Lautenbach, E, Han, J, Santana, E, Tolomeo, P, Bilker, W, Maslow, J. Colonization with extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species in long-term care facility residents. Infect Cont Hosp Epidemiol 2012;33:302304.
28.Yoo, J, Byeon, J, Yang, J, Yoo, J, Chung, G, Lee, Y. High prevalence of extended-spectrum β-lactamases and plasmid-mediate AmpC β-lactamases in Enterobacteriaceae isolated from long term care facilities in Korea. Diag Microbiol Infect Dis 2010;67:261265.
29.Gaviria, D, Greenfield, V, Bixler, D, et al.Carbapenem-resistant Klebsiella pneumoniae associated with a long term-care facility, West Virginia, 2009–2011. MMWR Morb Mortal Wkly Rep 2011;60:14181420.
30.Won, S, Munoz-Price, LS, lolans, K, Hota, B, Weinstein, R, Hayden, M. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase producing Enterobacteriaceae. Clin Infect Dis 2011;53:532540.
31.Wiener, J, Quinn, J, Bradford, P, et al.Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999;281:517523.
32.Claesson, MJ, Jeffery, IB, Conde, S, et al.Gut microbiota composition correlates with diet and health in the elderly. Nature 2012;488:178185.
33.Johnson, J, Porter, S, Zhanel, G, Kuskowski, M, Denamur, E. Virulence of Escherichia coli clinical isolates in a murine sepsis model in relation to sequence type ST131 status, fluoroquinolone resistance, and virulence genotype. Infect Immun 2012;80:15541562.
34.Lavigne, J-P, Bergunst, AC, Goret, L, et al.Virulence potential and genomic mapping of the worldwide clone Escherichia coli ST131. PLOS ONE 2012;7:e34294.


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