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Burgess MJ, Johnson JR, Porter SB, et al. Long-Term Care Facilities Are Reservoirs for Antimicrobial-Resistant Sequence Type 131 Escherichia coli. Open Forum Infect Dis. 2015;2(1):ofv011doi: 10.1093/ofid/ofv011.
Burgess, M. J., Johnson, J. R., Porter, S. B., Johnston, B., Clabots, C., Lahr, B. D., Uhl, J. R., & Banerjee, R. (2015). Long-Term Care Facilities Are Reservoirs for Antimicrobial-Resistant Sequence Type 131 Escherichia coli. Open forum infectious diseases, 2(1), ofv011. https://doi.org/10.1093/ofid/ofv011
Burgess, Mary J, et al. "Long-Term Care Facilities Are Reservoirs for Antimicrobial-Resistant Sequence Type 131 Escherichia coli." Open forum infectious diseases vol. 2,1 (2015): ofv011. doi: https://doi.org/10.1093/ofid/ofv011
Burgess MJ, Johnson JR, Porter SB, Johnston B, Clabots C, Lahr BD, Uhl JR, Banerjee R. Long-Term Care Facilities Are Reservoirs for Antimicrobial-Resistant Sequence Type 131 Escherichia coli. Open Forum Infect Dis. 2015 Feb 17;2(1):ofv011. doi: 10.1093/ofid/ofv011. eCollection 2015 Jan. PMID: 26034762; PMCID: PMC4438892.
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Open Forum Infect Dis. 2015 Feb 17;2(1):ofv011. doi: 10.1093/ofid/ofv011. eCollection 2015 Jan.

Long-Term Care Facilities Are Reservoirs for Antimicrobial-Resistant Sequence Type 131 Escherichia coli.

Open forum infectious diseases

Mary J Burgess, James R Johnson, Stephen B Porter, Brian Johnston, Connie Clabots, Brian D Lahr, James R Uhl, Ritu Banerjee

Affiliations

  1. University of Arkansas for Medical Sciences , Little Rock.
  2. Veterans Affairs Medical Center , Minneapolis, Minnesota ; University of Minnesota , Minneapolis.
  3. University of Minnesota , Minneapolis.
  4. Veterans Affairs Medical Center , Minneapolis, Minnesota.
  5. Mayo Clinic , Rochester, Minnesota.

PMID: 26034762 PMCID: PMC4438892 DOI: 10.1093/ofid/ofv011

Abstract

Background.  Emerging data implicate long-term care facilities (LTCFs) as reservoirs of fluoroquinolone-resistant (FQ-R) Escherichia coli of sequence type 131 (ST131). We screened for ST131 among LTCF residents, characterized isolates molecularly, and identified risk factors for colonization. Methods.  We conducted a cross-sectional study using a single perianal swab or stool sample per resident in 2 LTCFs in Olmsted County, Minnesota, from April to July 2013. Confirmed FQ-R E. coli isolates underwent polymerase chain reaction-based phylotyping, detection of ST131 and its H30 and H30-Rx subclones, extended virulence genotyping, and pulsed-field gel electrophoresis (PFGE) analysis. Epidemiological data were collected from medical records. Results.  Of 133 fecal samples, 33 (25%) yielded FQ-R E. coli, 32 (97%) of which were ST131. The overall proportion with ST131 intestinal colonization was 32 of 133 (24%), which differed by facility: 17 of 41 (42%) in facility 1 vs 15 of 92 (16%) in facility 2 (P = .002). All ST131 isolates represented the H30 subclone, with virulence gene and PFGE profiles resembling those of previously described ST131 clinical isolates. By PFGE, certain isolates clustered both within and across LTCFs. Multivariable predictors of ST131 colonization included inability to sign consent (odds ratio [OR], 4.16 [P = .005]), decubitus ulcer (OR, 4.87 [ P = .04]), and fecal incontinence (OR, 2.59 [P = .06]). Conclusions.  Approximately one fourth of LTCF residents carried FQ-R ST131 E. coli resembling ST131 clinical isolates. Pulsed-field gel electrophoresis suggested intra- and interfacility transmission. The identified risk factors suggest that LTCF residents who require increased nursing care are at greatest risk for ST131 colonization, possibly due to healthcare-associated transmission.

Keywords: E. coli; E. coli resistance; ST131; long-term care facilities

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