title: Extensive Household Outbreak of Urinary Tract Infection and Intestinal Colonization due to Extended-Spectrum β-Lactamase-Producing Escherichia coli Sequence Type 131.
abstract: BACKGROUND
  Reasons for the successful global dissemination of multidrug-resistant Escherichia coli sequence type 131 (ST131) are undefined, but may include enhanced transmissibility or ability to colonize the intestine compared with other strains.
  
  
  METHODS
  We identified a household in which 2 young children had urinary tract infection (UTI) caused by an extended-spectrum β-lactamase (ESBL)-producing, multidrug-resistant ST131 E. coli strain. We assessed the prevalence of ST131 intestinal colonization among the 7 household members (6 humans, 1 dog). Fecal samples, collected 3 times over a 19-week period, were cultured selectively for E. coli. Isolates were characterized using clone-specific polymerase chain reaction to detect ST131 and its ESBL-associated H30Rx subclone, pulsed-field gel electrophoresis, extended virulence genotyping, and antimicrobial susceptibility testing.
  
  
  RESULTS
  In total, 8 different E. coli pulsotypes (strains) were identified. The index patient's urine isolate represented ST131-H30Rx strain 903. This was the most widely shared and persistent strain in the household, colonizing 5 individuals at each sampling. In contrast, the 7 non-ST131 strains were each found in only 1 or 2 household members at a time, with variable persistence. The ST131 strain was the only strain with both extensive virulence and antimicrobial resistance profiles.
  
  
  CONCLUSIONS
  An ESBL-producing ST131-H30Rx strain caused UTI in 2 siblings, plus asymptomatic intestinal colonization in multiple other household members, and was the household's most extensively detected and persistent fecal E. coli strain. Efficient transmission and intestinal colonization may contribute to the epidemiologic success of the H30Rx subclone of E. coli ST131.
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester.
authors.forename: Theresa
authors.initials: T
authors.lastname: Madigan
authors.affiliation: Veterans Affairs Medical Center University of Minnesota, Minneapolis.
authors.forename: James R
authors.initials: JR
authors.lastname: Johnson
authors.affiliation: Veterans Affairs Medical Center University of Minnesota, Minneapolis.
authors.forename: Connie
authors.initials: C
authors.lastname: Clabots
authors.affiliation: Veterans Affairs Medical Center University of Minnesota, Minneapolis.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Johnston
authors.affiliation: Veterans Affairs Medical Center University of Minnesota, Minneapolis.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Porter
authors.affiliation: Veterans Affairs Medical Center University of Minnesota, Minneapolis.
authors.forename: Billie S
authors.initials: BS
authors.lastname: Slater
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ritu
authors.initials: R
authors.lastname: Banerjee
mesh_terms: D000818:Animals; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D002675:Child, Preschool; D016000:Cluster Analysis; D004196:Disease Outbreaks; D004285:Dogs; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000145:classification / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005191:Family Characteristics; D005192:Family Health; D005243:Feces / Q000382:microbiology*; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases
keywords: E. coli; ESBL; ST131
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