title: CTX-M-15-H30Rx-ST131 subclone is one of the main causes of healthcare-associated ESBL-producing Escherichia coli bacteraemia of urinary origin in Spain.
abstract: The objective of this study was to assess the prevalence and molecular epidemiology of ESBL-producing Escherichia coli causing healthcare-associated (HCA) and community-associated (CA) bacteraemia of urinary origin (BUO) in Spain.
  
  
  
  An observational cohort study was conducted at eight hospitals from different Spanish geographical areas (2010-11). BUO episodes (n = 425) were classified as HCA (n = 215) and CA (n = 210), and one blood isolate per episode was collected. Susceptibility testing was performed, ESBLs were screened by double-disc diffusion test and ESBL and OXA-1 genes were characterized (PCR and sequencing). Population structure (phylogenetic groups, XbaI-PFGE and MLST) and ST131 subtyping (PCR) were determined. Virulence genes were detected by PCR and virulence score, profiles and extraintestinal pathogenic E. coli (ExPEC) status calculated.
  
  
  
  ESBL-producing E. coli prevalence was 9.2% (39/425). ESBL-producing E. coli episodes were significantly associated with HCA-BUO episodes [14% (30/215) versus 4.3% (9/210); P = 0.001]. The highest non-susceptibility proportions corresponded to ciprofloxacin (97.4%), amoxicillin/clavulanate (74.4%), co-trimoxazole (69.2%) and tobramycin (61.5%). Of the 39 ESBL-producing E. coli isolates, 34 produced CTX-M enzymes (21 CTX-M-15, 11 CTX-M-14 and 2 CTX-M-1). Fifteen STs were identified, the B2-ST131 clone being the most prevalent (54%; 21/39). All ST131 isolates were ExPEC and had the highest virulence scores, but they showed less diversity in virulence profiles than other STs. The H30Rx subclone accounted for most ST131 isolates (20/21), co-produced CTX-M-15 (20/20) and OXA-1 (19/20) enzymes and was associated with HCA episodes (16/20).
  
  
  
  The CTX-M-15-ST131-H30Rx subclone is a relevant MDR pathogen causing BUO, mainly HCA episodes. The dominance of this subclone with comparatively less diversity of virulence profiles reflects the spread of a successful and MDR ESBL ST131 lineage in Spain.
authors: Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
authors: Irene
authors: I
authors: Merino
authors: Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.
authors: Evelyn
authors: E
authors: Shaw
authors: Departamento de Enfermedades Infecciosas, Hospital del Mar and Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain CEXS-Universitat Pompeu Fabra, Barcelona, Spain.
authors: Juan Pablo
authors: JP
authors: Horcajada
authors: Servicio de Microbiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Emilia
authors: E
authors: Cercenado
authors: Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain Servicio de Microbiología, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
authors: Beatriz
authors: B
authors: Mirelis
authors: Servicio de Microbiología, Complexo Hospitalario de Pontevedra, Pontevedra, Spain.
authors: M Angeles
authors: MA
authors: Pallarés
authors: Laboratori de Referència de Catalunya, Barcelona, Spain.
authors: Juliá
authors: J
authors: Gómez
authors: Servicio de Microbiología, Catlab, Hospital Universitari Mútua de Terrassa, Terrassa, Spain.
authors: M
authors: M
authors: Xercavins
authors: Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain Servicio de Microbiología, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain.
authors: Luis
authors: L
authors: Martínez-Martínez
authors: Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain.
authors: Marina
authors: M
authors: De Cueto
authors: Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
authors: Rafael
authors: R
authors: Cantón
authors: Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain pruizg@salud.madrid.org.
authors: Patricia
authors: P
authors: Ruiz-Garbajosa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D015331:Cohort Studies; D004926:Escherichia coli / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000145:classification / Q000453:epidemiology* / Q000235:genetics / Q000382:microbiology*; D005260:Female; D005838:Genotype; D006761:Hospitals; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D015995:Prevalence; D017422:Sequence Analysis, DNA; D013030:Spain / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000150:complications*; D037521:Virulence Factors / Q000235:genetics; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D037521:Virulence Factors; C473109:beta-lactamase CTX-M-15; D001618:beta-Lactamases