RT Journal Article
SR Electronic
T1 Epidemiology of the multidrug-resistant ST131-<em>H30</em> subclone among extraintestinal <em>Escherichia coli</em> collected from US children
JF bioRxiv
FD Cold Spring Harbor Laboratory
SP 122416
DO 10.1101/122416
A1 Arianna Miles-Jay
A1 Scott J. Weissman
A1 Amanda L. Adler
A1 Veronika Tchesnokova
A1 Evgeni V. Sokurenko
A1 Janet G. Baseman
A1 Danielle M. Zerr
YR 2017
UL http://biorxiv.org/content/early/2017/03/30/122416.abstract
AB Summary ST131-H30 was responsible for 5.3% of all extraintestinal E. coli infections and 44% of ESBL-producing extraintestinal E. coli infections among US children. The clinical and demographic correlates of infection with ST131-H30 differed between extended-spectrum cephalosporin-resistant and -sensitive isolates.Background E. coli ST131-H30 is a globally important pathogen implicated in rising rates of multidrug resistance, especially fluoroquinolone resistance and extended-spectrum beta-lactamase (ESBL) production, among E. coli causing extraintestinal infections. Previous studies have focused on adults, especially the elderly, leaving the epidemiology of H30 among children undefined.Methods We used clinical data and extraintestinal E. coli isolates from a case-control study conducted at four US freestanding children’s hospitals from 2009-2013 to estimate the burden and identify clinical and demographic correlates of infection with H30. H30 isolates were identified using fumC/fimH genotyping. Host correlates of H30 infection were examined using univariable and multivariable log-binomial regression models stratified by extended-spectrum cephalosporin resistance status.Results The estimated prevalence of ST131-H30 was 5.3% among all extraintestinal E. coli isolates and 44% among ESBL-producing isolates. The host correlates of infection with H30 differed by extended-spectrum cephalosporin resistance status: among resistant isolates, age ≤5 years was positively associated with H30 infection (relative risk [RR] 1.80, 95% confidence interval [CI] 1.18-2.86); among sensitive isolates, age ≤ years was negatively associated with H30 (RR 0.48, 95% CI 0.26-0.86), while presence of an underlying medical condition was positively associated with H30 (RR 4.19, 95% CI 2.32-8.00).Conclusions ST131-H30 is less common among extraintestinal E. coli collected from children compared to what has been reported among adults, possibly reflecting infrequent fluoroquinolone use in pediatrics; however, it is similarly dominant among ESBL-producing isolates. The H30 subclone appears to disproportionately affect young children relative to other extended-spectrum cephalosporin-resistant E. coli.