Molecular Characteristics of Extended-Spectrum-β-Lactamase-Producing Escherichia coli Isolates Causing Bacteremia in the Calgary Health Region from 2000 to 2007: Emergence of Clone ST131 as a Cause of Community-Acquired Infections

A study was designed to characterize extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli isolates causing bacteremia over an 8-year period (2000 to 2007) in a large well-defined geographical region. Molecular characterization was done by using isoelectric focusing; PCR; and sequencing of the bla(CTX-M-), bla(TEM-), bla(OXA-), bla(SHV-), and plasmid-mediated quinolone resistance determinants. Genetic relatedness was determined by pulsed-field electrophoresis with XbaI and multilocus sequence typing. A total of 67 patients with incident bloodstream infections were identified, and the majority presented with community-acquired infections involving the urinary and biliary tracts. Of the 67 ESBL-producing E. coli isolates recovered, 60 (90%) were positive for bla(CTX-M) genes; 32 (48%) produced CTX-M-15, 25 (37%) produced CTX-M-14, 1 (2%) produced CTX-M-24, 1 (2%) produced CTX-M-2, and 1 (2%) produced CTX-M-3, while 2 (3%)produced TEM- 52 and 5 (7%) produced SHV-2. Twenty-four (36%) isolates were positive for aac(6')-Ib-cr. The majority of isolates were resistant to ciprofloxacin (60 [ 90%] isolates) and gentamicin (40 [ 60%] isolates). The occurrence of ESBL-producing isolates was stable during the first 5 years, but there was a substantial increase from 2005 to 2007, mostly due to clone ST131, which produces CTX-M-15 and CTX-M-14, in blood cultures submitted from the community. Our results illustrated that E. coli clone ST131, which coproduces CTX-M-15, OXA- 1, TEM- 1, and aac(6')-Ib-cr, has emerged as an important cause of community- onset bacteremia caused by ESBL-producing E. coli isolates; and this is the first study to identify CTX-M-14 in E. coli clone ST131.