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      Clinical epidemiology and molecular analysis of extended-spectrum-β-lactamase-producing Escherichia coli in Nepal: characteristics of sequence types 131 and 648.

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          Abstract

          Recently, CTX-M-type extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli strains have emerged worldwide. In particular, E. coli with O antigen type 25 (O25) and sequence type 131 (ST131), which is often associated with the CTX-M-15 ESBL, has been increasingly reported globally; however, epidemiology reports on ESBL-producing E. coli in Asia are limited. Patients with clinical isolates of ESBL-producing E. coli in the Tribhuvan University teaching hospital in Kathmandu, Nepal, were included in this study. Whole-genome sequencing of the isolates was conducted to analyze multilocus sequence types, phylotypes, virulence genotypes, O25b-ST131 clones, and distribution of acquired drug resistance genes. During the study period, 105 patients with ESBL-producing E. coli isolation were identified, and the majority (90%) of these isolates were CTX-M-15 positive. The most dominant ST was ST131 (n = 54; 51.4%), followed by ST648 (n = 15; 14.3%). All ST131 isolates were identified as O25b-ST131 clones, subclone H30-Rx. Three ST groups (ST131, ST648, and non-ST131/648) were compared in further analyses. ST648 isolates had a proportionally higher resistance to non-β-lactam antibiotics and featured drug-resistant genes more frequently than ST131 or non-ST131/648 isolates. ST131 possessed the most virulence genes, followed by ST648. The clinical characteristics were similar among groups. More than 38% of ESBL-producing E. coli isolates were from the outpatient clinic, and pregnant patients comprised 24% of ESBL-producing E. coli cases. We revealed that the high resistance of ESBL-producing E. coli to multiple classes of antibiotics in Nepal is driven mainly by CTX-M-producing ST131 and ST648. Their immense prevalence in the communities is a matter of great concern.

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          Author and article information

          Journal
          Antimicrob. Agents Chemother.
          Antimicrobial agents and chemotherapy
          1098-6596
          0066-4804
          2015
          : 59
          : 6
          Affiliations
          [1 ] Department of Clinical Microbiology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
          [2 ] Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan kayokohayakawa@gmail.com.
          [3 ] Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
          [4 ] Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
          [5 ] Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
          [6 ] Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
          [7 ] Department of International Medical Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
          [8 ] Public Health Research Laboratory, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
          Article
          AAC.00270-15
          10.1128/AAC.00270-15
          4432170
          25824221
          78e19711-ca45-43e3-b15f-a83d3acc0c44
          Copyright © 2015, American Society for Microbiology. All Rights Reserved.
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