title: Variation in resistance traits, phylogenetic backgrounds, and virulence genotypes among Escherichia coli clinical isolates from adjacent hospital campuses serving distinct patient populations.
abstract: Escherichia coli sequence type 13 (ST131), an emergent cause of multidrug-resistant extraintestinal infections, has important phylogenetic subsets, notably the H30 and H30Rx subclones, with distinctive resistance profiles and, possibly, clinical associations. To clarify the local prevalence of these ST131 subclones and their associations with antimicrobial resistance, ecological source, and virulence traits, we extensively characterized 233 consecutive E. coli clinical isolates (July and August 2013) from the University of Minnesota Medical Center-Fairview Infectious Diseases and Diagnostic Laboratory, Minneapolis, MN, which serves three adjacent facilities (a children's hospital and low- and high-acuity adult facilities). ST131 accounted for 26% of the study isolates (more than any other clonal group), was distributed similarly by facility, and was closely associated with ciprofloxacin resistance and extended-spectrum β-lactamase (ESBL) production. The H30 and H30Rx subclones accounted for most ST131 isolates and for the association of ST131 with fluoroquinolone resistance and ESBL production. Unlike ST131 per se, these subclones were distributed differentially by hospital, being most prevalent at the high-acuity adult facility and were absent from the children's hospital. The virulence gene profiles of ST131 and its subclones were distinctive and more extensive than those of other fluoroquinolone-resistant or ESBL-producing isolates. Within ST131, bla CTX-M-15 was confined to H30Rx isolates and other bla CTX-M variants to non-Rx H30 isolates. Pulsed-field gel electrophoresis documented a predominance of globally distributed pulsotypes and no local outbreak pattern. These findings help clarify the epidemiology, ecology, and bacterial correlates of the H30 and H30Rx ST131 subclones by documenting a high overall prevalence but significant segregation by facility, strong associations with fluoroquinolone resistance and specific ESBL variants, and distinctive virulence gene associations that may confer fitness advantages over other resistant E. coli.
authors.affiliation: University of Minnesota, Minneapolis, Minnesota, USA drawz007@umn.edu.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Drawz
authors.affiliation: Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Porter
authors.affiliation: Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuskowski
authors.affiliation: Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Johnston
authors.affiliation: Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Connie
authors.initials: C
authors.lastname: Clabots
authors.affiliation: University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Kline
authors.affiliation: University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ferrieri
authors.affiliation: University of Minnesota, Minneapolis, Minnesota, USA Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Johnson
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002939:Ciprofloxacin / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D004926:Escherichia coli / Q000187:drug effects / Q000235:genetics* / Q000472:pathogenicity*; D029968:Escherichia coli Proteins / Q000235:genetics / Q000378:metabolism; D024841:Fluoroquinolones / Q000494:pharmacology; D005838:Genotype; D006761:Hospitals; D006801:Humans; D010802:Phylogeny; D014774:Virulence / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D029968:Escherichia coli Proteins; D024841:Fluoroquinolones; D002939:Ciprofloxacin