Detection of Sequence Type 131 in Escherichia Coli Isolates from urinary tract infection: Association with Fluoroquinolone-Resistance and extended-spectrum β-lactamase Production

Abstract

E. coli ST131 has emerged as a global epidemic, multidrug-resistant clone of E. coli causing extra-intestinal infections. It is highly prevalent among fluoroquinolone-resistant and ESBL-producing E. coli isolates worldwide. Humans are likely the primary reservoir of ST131. E. coli ST131 causes a wide range of infections ranging from cystitis to life-threatening sepsis. Phenotypic detection of the ST131 clone is not possible and DNA-based techniques, including MLST and PCR, are described. UTI is one of the most common bacterial infections and accounts for significant morbidity and mortality with high medical costs. Although fluoroquinolones are particularly useful for the treatment of UTIs, because high concentrations in the urine can be achieved and their broad-spectrum activity, however fluoroquinolones and trimethoprim-sulfamethoxazole are no longer adequate options for empiric therapy when E. coli ST131 is suspected from local epidemiology. Expanded-spectrum cephalosporins, piperacillin-tazobactam and carbapenems are options to treat serious non-ESBL-producing E. coli ST131 infections, while carbapenems are indicated for ESBL-producing infections. There is a growing interest in re-evaluating oral agents including fosfomycin for less serious infections such as uncomplicated cystitis.