由多重耐药性大肠杆菌克隆群引起的尿路感染广泛传播。

Widespread distribution of urinary tract infections caused by a multidrug-resistant Escherichia coli clonal group.

作者信息

Manges A R, Johnson J R, Foxman B, O'Bryan T T, Fullerton K E, Riley L W

机构信息

Division of Epidemiology and Public Health Biology, School of Public Health, University of California at Berkeley, 94720, USA.

出版信息

N Engl J Med. 2001 Oct 4;345(14):1007-13. doi: 10.1056/NEJMoa011265.

DOI:10.1056/NEJMoa011265

PMID:11586952

Abstract

BACKGROUND

The management of urinary tract infections is complicated by the increasing prevalence of antibiotic-resistant strains of Escherichia coli. We studied the clonal composition of E. coli isolates that were resistant to trimethoprim-sulfamethoxazole from women with community-acquired urinary tract infections.

METHODS

Prospectively collected E. coli isolates from women with urinary tract infections in a university community in California were evaluated for antibiotic susceptibility, O:H serotype, DNA fingerprinting, pulsed-field gel electrophoretic pattern, and virulence factors. The prevalence and characteristics of an antibiotic-resistant clone were evaluated in this group of isolates and in those from comparison cohorts in Michigan and Minnesota.

RESULTS

Fifty-five of the 255 E. coli isolates (22 percent) from the California cohort were resistant to trimethoprim-sulfamethoxazole as well as other antibiotics. There was a common pattern of DNA fingerprinting, suggesting that the isolates belonged to the same clonal group (clonal group A), in 28 of 55 isolates with trimethoprim-sulfamethoxazole resistance (51 percent) and in 2 of 50 randomly selected isolates that were susceptible to trimethoprim-sulfamethoxazole (4 percent, P<0.001). In addition, 11 of 29 resistant isolates (38 percent) from the Michigan cohort and 7 of 18 (39 percent) from the Minnesota cohort belonged to clonal group A. Most of the clonal group A isolates were serotype O11:H(nt) or O77:H(nt), with similar patterns of virulence factors, antibiotic susceptibility, and electrophoretic features.

CONCLUSIONS

In three geographically diverse communities, a single clonal group accounted for nearly half of community-acquired urinary tract infections in women that were caused by E. coli strains with resistance to trimethoprim-sulfamethoxazole. The widespread distribution and high prevalence of E. coli clonal group A has major public health implications.

摘要

背景

大肠埃希菌抗生素耐药菌株的日益流行使尿路感染的管理变得复杂。我们研究了社区获得性尿路感染女性中对甲氧苄啶 - 磺胺甲恶唑耐药的大肠埃希菌分离株的克隆组成。

方法

对加利福尼亚大学社区前瞻性收集的尿路感染女性的大肠埃希菌分离株进行抗生素敏感性、O:H血清型、DNA指纹图谱、脉冲场凝胶电泳图谱和毒力因子评估。在这组分离株以及密歇根州和明尼苏达州的对照队列分离株中评估抗生素耐药克隆的流行率和特征。

结果

加利福尼亚队列的255株大肠埃希菌分离株中有55株（22%）对甲氧苄啶 - 磺胺甲恶唑以及其他抗生素耐药。在55株对甲氧苄啶 - 磺胺甲恶唑耐药的分离株中有28株（51%）以及在50株随机选择的对甲氧苄啶 - 磺胺甲恶唑敏感的分离株中有2株（4%，P<0.001）存在共同的DNA指纹图谱模式，表明这些分离株属于同一克隆组（克隆组A）。此外，密歇根队列的29株耐药分离株中有11株（38%）以及明尼苏达队列的18株中有7株（39%）属于克隆组A。大多数克隆组A分离株为血清型O11:H(nt)或O77:H(nt)，具有相似的毒力因子模式、抗生素敏感性和电泳特征。