title: Prevalence and Antimicrobial Resistance Patterns of Diarrheagenic Escherichia coli in Shanghai, China.
abstract: BACKGROUND
  Diarrheagenic Escherichia coli (DEC) is a major cause of bacterial gastroenteritis in children. Also, antibiotic resistance among DEC is becoming a critical area of concern in clinical settings.
  
  
  METHODS
  This study was conducted in 4 hospitals in Shanghai from June 2012 to October 2013. DEC isolates from stool samples of patients with diarrhea were examined to determine their antimicrobial susceptibilities and presence of virulence genes, in order to identify high risk clones.
  
  
  RESULTS
  A total of 735 (10.2%) DEC isolates were identified from 7204 stool samples from patients with diarrhea, including 374 enteropathogenic E. coli, 318 enterotoxigenic E. coli, 36 Shigella/enteroinvasive E. coli and 7 Shiga toxin-producing E. coli (STEC). Among the 735 DEC isolates, 299 (40.7%) were isolated from children less than 5 years old. High resistance rates were observed to streptomycin (90.7%), ampicillin (63.4%), nalidixic acid (61.1%), sulfisoxazole (49.1%), tetracycline (41.2%), trimethoprim (35.6%), trimethoprim-sulfamethoxazole (35.4%), followed by amoxicillin-clavulanic acid (27.2%), cefotaxime (24.5%), cefepime (23.5%), gentamicin (16.7%), ceftazidime (12.4%), chloramphenicol (10.6%), ciprofloxacin (7.2%) and ofloxacin (3.4%). All the isolates were susceptible to imipenem. In addition, potential virulence genes were screened by polymerase chain reaction. A total of 15 enterotoxigenic E. coli belonging to the same clone were identified to be associated with nosocomial neonatal diarrhea and resistant to greater than 10 antimicrobials.
  
  
  CONCLUSIONS
  Our findings suggest that active surveillance programs combining both phenotypic and genetic data would help identify disease outbreaks and strengthen antibiotic management.
authors.affiliation: From the *Department of Microbiological Lab, The Changning District Center for Disease Control and Prevention, Shanghai, China; †Department of Food Science and Technology, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai, China; ‡Department of Microbial Technology and Research, Shanghai Municipal Ke-ma-jia Technology Center for Microbiology, Shanghai, China; §Department of Clinical Microbiological Lab, Shanghai United Family Hospital, Shanghai, China; ¶Department of Food Science Center, Mérieux NutriSciences China Food Science Center, Shanghai, China; ‖Department of Clinical Microbiological Lab, Children Hospital of Fudan University, Shanghai, China; **Key Laboratory of Veterinary Vaccine Innovation of the Ministry of Agriculture, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China; ††Department of Food Science and Nutrition, University of Maryland, College Park, Maryland; and ‡‡Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Huang
authors.forename: Haijian
authors.initials: H
authors.lastname: Pan
authors.forename: Pingping
authors.initials: P
authors.lastname: Zhang
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Cao
authors.forename: Wenting
authors.initials: W
authors.lastname: Ju
authors.forename: Chuanqing
authors.initials: C
authors.lastname: Wang
authors.forename: Jianmin
authors.initials: J
authors.lastname: Zhang
authors.forename: Jianghong
authors.initials: J
authors.lastname: Meng
authors.forename: Zhengan
authors.initials: Z
authors.lastname: Yuan
authors.forename: Xuebin
authors.initials: X
authors.lastname: Xu
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002681:China; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000472:pathogenicity; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents