– This finding represents an epidemiological change in extended-expectrum-beta-lactamases (ESBLs) distribution in Europe
– This study results from the collaboration of the Preventive Medicine and Microbiology Departments at Hospital Universitario Ramón y Cajal (Madrid) with a European multicentre project (R-GNOSIS) funded by the EU and it has been recently awarded as best communication in the XXII Congress of SEIMC
The E. coli-ST131 clone is associated with urinary tract infections and bacteraemia. Its high level of resistance to several antibiotic families represents a public health problem. Among the clades that conform its population structure, clade C2 is associated with extended-spectrum betalactamases (ESBLs) production, mainly CTX-M-15. Recently, a new subclade has been described among clade C1, named clade C1-M27, associated with the production of CTX-M-27 and responsible for the increase in ESBL-E. coli extraintestinal infections in Asia. This new clade has also been described among isolates from France and Germany.
Our group has participated in the R-GNOSIS project, whose aim is to analyse different strategies for the prevention of the nosocomial transmission of ESBL-producers, and that took place in 4 European hospitals (Berlin, Madrid, Geneva and Utrecht) from March 2014 to February 2015. During this project, 688 colonizing ESBL-E. coli from hospitalized patients were studied to assess ST131 prevalence. Among the results, it stood out the high prevalence of CTX-M-27 production among ST131 isolates (27%), the most common ESBL behind CTX-M-15 (49%), especially compared to its prevalence among a subset of non-ST131 isolates from the same collection, where only 4% of the isolates produced CTX-M-27. The majority of CTX-M-27-ST131 isolates grouped within the newly described clade C1-M27. They were found in all 4 participating hospitals (mainly Geneva) and demonstrated a high clonal relationship, which suggest a recent emergence. Moreover, they showed an antibiotic resistance profile distinctly different from C2 isolates. More studies are needed to understand the expansion dynamics of this new clade and its repercussion in clinical practice.
This study has been presented in several national and international congresses, and the communication by Dra. Merino, postdoctoral researcher of our group, was awarded best communication in the XXII Congress of SEIMC (Bilbao, 24-26th of May 2018). It has also led to a publication in an international journal (in review). This study is among the different projects related to antimicrobial resistance that our group is implicated with and that are being developed by the Spanish Network of Research in Infectious Diseases (REIPI), funded by Instituto de Salud Carlos III (RD12/0015/0004 y RD16/0016/0011).
Dra. Irene Merino, Dra. Patricia Ruiz-Garbajosa and Dr. Rafael Cantón
Twitter: @RafaMCanton @Merino3_san