Analysis of #drug #resistance of #ESBL-producing #Escherichia coli and #Klebsiella pneumoniae in #children with #UTI (Saudi Med J., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Saudi Med J. 2019 Nov;40(11):1111-1115. doi: 10.15537/smj.2019.11.24547.

Analysis of drug resistance of extended-spectrum beta-lactamases-producing Escherichia coli and Klebsiella pneumoniae in children with urinary tract infection.

Keshi L1, Weiwei X, Shoulin L, Xiadong L, Hao W, Junhai J, Xiangwei W, Rui W, Pei Z.

Author information: 1 Department of Urology, Shenzhen Children’s Hospital,Shenzhen,Guangdong Province, China. E-mail.




To investigate the drug resistance of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli ) and Klebsiella pneumoniae (K. pneumoniae) in children with urinary tract infection  (UTI) and to provide the rationale for clinical use of antibiotics.


This is a retrospective analysis of drug susceptibility in children with E. coli or K. pneumoniae-positive urine culture between August 2013 and August 2017,  Shenzhen Children’s Hospital, Shenzhen, China. Drug resistance was statistically assessed using Fisher exact test and χ2 test.


A total of 698 cases of E. coli, 426 of which were confirmed ESBL-producing strains, and 217 cases of K. pneumoniae, including 111 ESBL-producing strains, were detected, and the difference in proportion of positive ESBL-producing strains (61.03% versus 51.15%) was statistically significant (p=0.010). The average drug resistance rates of E. coli and K. pneumoniae to piperacillin/tazobactam, meropenem, ertapenem, imipenem, and amikacin were less than 15%. The average resistance rates of ESBL-producing E. coli and K. pneumoniae to cefpodoxime, cefixime, cefazolin, and ceftriaxone was less than 98%, while average resistance rates for non-ESBL-producing bacteria to the above 4 drugs was less than 20%.


In southern China, the proportion of ESBL-producing strains and the drug resistance rates of E. coli and K. pneumoniae in UTI in children was high, but their resistance rates to carbapenems and β-lactamase inhibitor complexes containing tazobactam were low. Carbapenems are the most effective antibacterial drugs for the treatment of ESBL-producing bacteria.

PMID: 31707407 DOI: 10.15537/smj.2019.11.24547

Keywords: Antibiotics; Drugs Resistance; Beta-lactams; Carbapenem; E. Coli; Klebsiella pneumoniae; UTI; China; Pediatrics.


#Bloodstream #infections caused by #Escherichia coli in #onco-haematological patients: #Risk #factors and #mortality in an #Italian prospective survey (PLOS One, abstract)

[Source: PLOS One, full page: (LINK). Abstract, edited.]


Bloodstream infections caused by Escherichia coli in onco-haematological patients: Risk factors and mortality in an Italian prospective survey

Enrico Maria Trecarichi , Gabriele Giuliano, Chiara Cattaneo, Stelvio Ballanti, Marianna Criscuolo, Anna Candoni, Francesco Marchesi, Marica Laurino, Michelina Dargenio, Rosa Fanci, Mariagiovanna Cefalo, Mario Delia, Angelica Spolzino,  [ … ], for the Haematologic Malignancies Associated Bloodstream Infections Surveillance (HEMABIS) registry–Sorveglianza Epidemiologica Infezioni Fungine in Emopatie Maligne (SEIFEM) group, Italy


Published: October 29, 2019 / DOI:



Bloodstream infections (BSIs) remain life-threatening complications in the clinical course of patients with haematological malignancies (HM) and Escherichia coli represent one of the most frequent cause of such infections. In this study, we aimed to describe risk factors for resistance to third generation cephalosporins and prognostic factors, including the impact of third generation cephalosporins resistance, in patients with HM and BSIs caused by E. coli. Three hundred forty-two cases of E. coli BSIs were collected during the study period (from January 2016 to December 2017). The percentage of resistance to third generation cephalosporins was 25.7%. In multivariate analysis, the variables recent endoscopic procedures, culture-positive surveillance rectal swabs for multidrug-resistant bacteria, antibiotic prophylaxis with fluoroquinolones, and prolonged neutropenia were independently associated with bloodstream infections caused by a third generation cephalosporins resistant E. coli. The overall 30-day mortality rate was 7.1%. Cox regression revealed that significant predictors of mortality were acute hepatic failure, septic shock, male sex, refractory/relapsed HM, and third generation cephalosporins resistance by E. coli isolate. In conclusion, resistance to third generation cephalosporins adversely affected the outcomes of bloodstream infections caused by E. coli in our cohort of HM patients. We also found a significant correlation between prophylaxis with fluoroquinolones and resistance to third generation cephalosporins by E. coli isolates.


Citation: Trecarichi EM, Giuliano G, Cattaneo C, Ballanti S, Criscuolo M, Candoni A, et al. (2019) Bloodstream infections caused by Escherichia coli in onco-haematological patients: Risk factors and mortality in an Italian prospective survey. PLoS ONE 14(10): e0224465.

Editor: Peter Gyarmati, University of Illinois College of Medicine, UNITED STATES

Received: June 3, 2019; Accepted: October 14, 2019; Published: October 29, 2019

Copyright: © 2019 Trecarichi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data cannot be made publicly available due to ethical restrictions imposed by Italian legislation and ethic committees of the study coordinating center and of any other participating centers. For additional information, please contact the corresponding author, Professor Enrico M Trecarichi ( or the ethic committee of the study coordinating center (Fondazione Policlinico Universitario Agostino Gemelli IRCCS – Università Cattolica del Sacro Cuore; E-mail:

Funding: The author(s) received no specific funding for this work.

Competing interests: EMT has been a speaker at accredited educational courses funded by unrestricted grants from Pfizer and Mattioli 1885. MT has been a scientific advisor/consultant for Angelini, Gilead, MSD, Nordic Pharma, and Roche, and speaker/chairman at accredited educational courses funded by unrestricted grants from Astellas, Gilead, MSD, and Pfizer. LP received honoraria for Advisory Board from Gilead Sciences, MSD, Pfizer, Jazz, Janssen, Menarini and Cidara, and has been speaker for Gilead Sciences, MSD, Pfizer, Celgine, Novartis, Astellas Pharma. MD received honoraria for Advisory Board from Honoraria from MSD, Gilead, and Pfizer. AB received honoraria for Advisory Board from Gilead, Pfizer, MSD, and Jazz. None of the other authors has any conflicts of interest to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Keywords: Antibiotics; Drugs Resistance; E. Coli; Fluoroquinolones; Cephalosporins; Cancer; Italy.


Simultaneous #Infection with #Enterobacteriaceae and #Pseudomonas aeruginosa harboring Multiple #Carbapenemases in a Returning #Traveler colonized with #Candida auris (AAC, abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Simultaneous Infection with Enterobacteriaceae and Pseudomonas aeruginosa harboring Multiple Carbapenemases in a Returning Traveler colonized with Candida auris

Ayesha Khan, William C. Shropshire, Blake Hanson, An Q. Dinh, Audrey Wanger, Luis Ostrosky-Zeichner, Cesar A. Arias, William R. Miller

DOI: 10.1128/AAC.01466-19



We report our clinical experience treating a critically ill patient with polymicrobial infections due to multi-drug resistant Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa in a 56 year-old woman who received healthcare in India and was also colonized by Candida auris. A precision medicine approach using whole genome sequencing revealed a multiplicity of mobile elements associated with NDM-1, NDM-5, and OXA-181 and, supplemented by susceptibility testing, guided the selection of rational antimicrobial therapy.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; NDM1; E. Coli; Klebsiella pneumoniae; Pseudomonas aeruginosa; Candida auris.


#ESBL-producing #Escherichia coli in #human-derived and #foodchain-derived #samples from #England, #Wales, and #Scotland: an epidemiological surveillance and typing study (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Extended-spectrum β-lactamase-producing Escherichia coli in human-derived and foodchain-derived samples from England, Wales, and Scotland: an epidemiological surveillance and typing study

Michaela J Day, PhD, Katie L Hopkins, PhD, David W Wareham, PhD, Mark A Toleman, PhD, Nicola Elviss, PhD, Luke Randall, PhD, Christopher Teale, MSc, Paul Cleary, MSc, Camilla Wiuff, PhD *, Michel Doumith, PhD †, Matthew J Ellington, PhD, Neil Woodford, PhD, Prof David M Livermore, PhD

Open Access / Published: October 22, 2019 / DOI:




Extended-spectrum β-lactamase-producing Escherichia coli isolates (ESBL-E coli) cause more than 5000 cases of bacteraemias annually in the UK. The contribution of the food chain to these infections is debated. We aimed to identify the most important reservoirs of ESBL-E coli that colonise and infect humans to identify strategic intervention points.


Sampling for ESBL-E coli was done between Aug 1, 2013, and Dec 15, 2014. We used selective media to seek ESBL-E coli in routinely submitted samples from human faeces, and prospectively collected samples from sewage, farm slurry, and retail foodstuffs in London, East Anglia, northwest England, Scotland, and Wales. We sequenced recovered isolates and compared these isolates with 293 bloodstream and 83 veterinary surveillance ESBL-E coli isolates from the same regions.


2157 (11%) of 20 243 human faeces samples contained ESBL-E coli, including 678 (17%) of 3995 in London. ESBL-E coli also were frequent in sewage and retail chicken (104 [65%] of 159 meat samples), but were rare in other meats and absent from plant-based foods (0 of 400 fruit and vegetable samples). Sequence type (ST) 131 dominated among ESBL-E coli from human blood (188 [64%] of 293 isolates), faeces (128 [36%] of 360), and sewage (14 [22%] of 65) with STs 38 and 648 also widespread; CTX-M-15 was the predominant ESBL in these lineages (319 [77%] of 416). By contrast, STs 602, 23, and 117—mostly with CTX-M-1 ESBL—dominated among food and veterinary isolates (68 [31%] of 218), with only two ST131 organisms recovered. ST10 occurred in both animals and humans, being frequent in surveillance bovines (11 [22%] of 51 cattle) and representing 15 (4%) of 360 human faecal isolates (but only three [1%] of 293 from bacteraemias); however, both human and animal ST10 isolates were diverse in serotype.


Most human bacteraemias with ESBL-E coli in the UK involve internationally prevalent human-associated STs, particularly ST131; non-human reservoirs made little contribution to invasive human disease. Any interventions that seek to target food or livestock can affect the numbers of human infections caused by ESBL-E coli; prevention of the spread of resistant lineages among humans is more vital.


NIHR Policy Research.

Keywords: Antibiotics; Drugs Resistance; Beta-lactams; Food Safety; UK.


#Human carriage of #cefotaxime-resistant #Escherichia coli in North-East #India: an analysis of STs and associated resistance mechanisms (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Human carriage of cefotaxime-resistant Escherichia coli in North-East India: an analysis of STs and associated resistance mechanisms

Deepjyoti Paul, Dmitriy Babenko, Mark A Toleman

Journal of Antimicrobial Chemotherapy, dkz416,

Published: 17 October 2019




To determine the prevalence of Escherichia coli STs and associated resistance mechanisms carried by the community in North-East India.


E. coli (108) were isolated from sewage collected from 19 sites across the city of Silchar by plating on MacConkey agar with/without selection (50 mg/L cefotaxime). Species identification was confirmed by MALDI-TOF MS for 82 isolates. Common resistance mechanisms were determined by WGS of pooled E. coli isolates. PFGE combined with specific probes determined the presence of common resistance mechanisms in all isolates. Phylotypes, multilocus STs, core-genome multilocus STs, resistance genes and virulence genes were determined by in silico analysis of 38 genomes.

Results and conclusions

Analysis of isolates collected without selection (n = 33) indicated that cefotaxime resistance in E. coli was 42% (14/33) and estimated meropenem resistance at 9%. The remaining 58% (19/33) were additionally susceptible to ampicillin, trimethoprim, ciprofloxacin and aminoglycosides. The most common ST among the cefotaxime-resistant E. coli was ST167 (29%), followed by ST410 (17%) and ST648 (10%). E. coli ST131 was absent from the collection. Sixty-three isolates were resistant to cefotaxime and harboured blaCTX-M-15 [54% (34/63)] or blaCMY-42 [46% (29/63)], of which 10% (6/63) harboured both genes. Carbapenem resistance was due to blaNDM-5, found in 10/63 cefotaxime-resistant isolates, and/or blaOXA-181, found in 4/63 isolates. NDM-5 was encoded by IncX3 and/or IncFII plasmids and CMY-42 was mostly encoded by IncI plasmids. NDM-5 appears to have replaced NDM-1 in this region and CMY-42 appears to be in the process of replacing CTX-M-15.

Keywords: Antibiotics; Drugs Resistance; Cefotaxime; E. Coli; NDM1; NDM5; India.


#Shedding of #OXA-181 #carbapenemase-producing #Escherichia coli from companion #animals after #hospitalisation in #Switzerland: an outbreak in 2018 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Shedding of OXA-181 carbapenemase-producing Escherichia coli from companion animals after hospitalisation in Switzerland: an outbreak in 2018

Aurélien Nigg1, Michael Brilhante1,2, Valentina Dazio3, Mathieu Clément2,5, Alexandra Collaud1, Stefanie Gobeli Brawand1, Barbara Willi4, Andrea Endimiani5, Simone Schuller3, Vincent Perreten1

Affiliations: 1 Institute of Veterinary Bacteriology, Bern, University of Bern; 2 Graduate School of Cellular and Biomedical Sciences, Bern, University of Bern; 3 Department of Clinical Veterinary Medicine, Bern, University of Bern; 4 Clinic for Small Animal Internal Medicine, University of Zurich, Zurich, Switzerland; 5 Institute for Infectious Diseases, University of Bern, Bern, Switzerland

Correspondence: Vincent

Citation style for this article: Nigg Aurélien, Brilhante Michael, Dazio Valentina, Clément Mathieu, Collaud Alexandra, Gobeli Brawand Stefanie, Willi Barbara, Endimiani Andrea, Schuller Simone, Perreten Vincent. Shedding of OXA-181 carbapenemase-producing Escherichia coli from companion animals after hospitalisation in Switzerland: an outbreak in 2018. Euro Surveill. 2019;24(39):pii=1900071.

Received: 22 Jan 2019;   Accepted: 19 May 2019




Carbapenem-resistant Enterobacteriaceae pose a serious threat to public health worldwide, and the role of companion animals as a reservoir is still unclear.


This 4-month prospective observational study evaluated carriage of carbapenem-resistant Enterobacteriaceae at admission and after hospitalisation in a large referral hospital for companion animals in Switzerland.


Rectal swabs of dogs and cats expected to be hospitalised for at least 48 h were taken from May to August 2018 and analysed for the presence of carbapenem-resistant Enterobacteriaceae using selective agar plates. Resistant isolates were further characterised analysing whole genome sequences for resistance gene and plasmid identification, and ad hoc core genome multilocus sequence typing.


This study revealed nosocomial acquisition of Escherichia coli harbouring the carbapenemase gene blaOXA-181, the pAmpC cephalosporinase gene blaCMY-42 as well as quinolone resistance associated with qnrS1 and mutations in the topoisomerases II (GyrA) and IV (ParC). The blaOXA-181 and qnrS1 genes were identified on a 51 kb IncX3 plasmid and blaCMY-42 on a 47 kb IncI1 plasmid. All isolates belonged to sequence type ST410 and were genetically highly related. This E. coli clone was detected in 17 of 100 dogs and four of 34 cats after hospitalisation (21.6%), only one of the tested animals having tested positive at admission (0.75%). Two positive animals were still carriers 4 months after hospital discharge, but were negative after 6 months.


Companion animals may acquire carbapenemase-producing E. coli during hospitalisation, posing the risk of further dissemination to the animal and human population and to the environment.

© This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; E. Coli; Cats; Dogs; Switzerland.


A ten-year review of #ESBL and non-ESBL #Escherichia coli #bloodstream #infections among #children at a tertiary referral #hospital in South Africa [#ZA] (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]


A ten-year review of ESBL and non-ESBL Escherichia coli bloodstream infections among children at a tertiary referral hospital in South Africa

Oliver Ombeva Malande , James Nuttall, Vashini Pillay, Colleen Bamford, Brian Eley

Published: September 24, 2019 / DOI:




There are few studies describing Escherichia coli (E. coli) bloodstream infection (BSI) among children in Africa, yet E.coli is increasing in importance as a cause of antibiotic resistant infection in paediatric settings.


In this retrospective, descriptive study aspects of E. coli BSI epidemiology are described over a 10-year period including incidence risk, risk factors for extended-spectrum β-lactamase (ESBL)-producing E. coli BSI, antibiotic susceptibility of the bacterial isolates and outcome including risk factors for severe disease.


There were 583 new E. coli BSI episodes among 217,483 admissions, an overall incidence risk of 2.7 events/1,000 hospital admissions. Of 455 of these E. coli BSI episodes that were analysed, 136 (29.9%) were caused by ESBL-producing isolates. Risk factors for ESBL-producing E. coli BSI included hospitalization in the 28-day period preceding E. coli BSI episodes, having an underlying chronic illness other than HIV infection at the time of the E. coli BSI and having a temperature of 38° Celsius or higher at the time of the E. coli BSI. None of the E. coli isolates were resistant to carbapenems or colistin. The mortality rate was 5.9% and admission to the intensive care unit was required in 12.3% of BSI episodes. Predictors of severe disease included age less than 1 month, hospitalization in the 28-day period preceding E. coli BSI and BSI without a definable focus.


These findings extend our understanding of E. coli BSI in a sub-Saharan African setting, provide useful information that can guide empiric treatment choices for community- and hospital-acquired BSI and help inform prevention strategies.


Citation: Malande OO, Nuttall J, Pillay V, Bamford C, Eley B (2019) A ten-year review of ESBL and non-ESBL Escherichia coli bloodstream infections among children at a tertiary referral hospital in South Africa. PLoS ONE 14(9): e0222675.

Editor: Surbhi Leekha, University of Maryland School of Medicine, UNITED STATES

Received: April 30, 2019; Accepted: September 3, 2019; Published: September 24, 2019

Copyright: © 2019 Malande et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: There was no special funding for this work, except patient folders and clinical records and staff input from the Red Cross Hospital Children’s Hospital – Paediatric infectious Diseases unit and University of Cape Town.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Antibiotics; Drugs Resistance; E. Coli; Carbapenem; Colistin; Beta-lactams; Bacteremia; Pediatrics; South Africa.