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Title: | Demographic, clinical and molecular epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli bloodstream infections in Central Australia. | Austin Authors: | Langham, Freya;Tsai, Danny;Forde, Brian M;Camilleri, Shayne;Harris, Patrick N A;Roberts, Jason A;Chiong, Fabian | Affiliation: | Department of Infectious Diseases, Monash Health, Melbourne, Vic, Australia; Alice Springs Hospital, Central Australian Health Service, Alice Springs, NT, Australia. University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia. Alice Springs Hospital, Central Australian Health Service, Alice Springs, NT, Australia. University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia; Central Microbiology, Pathology Queensland, Royal Brisbane & Women's Hospital, Brisbane, Qld, Australia. Infectious Diseases |
Issue Date: | 9-Jul-2024 | Date: | 2024 | Publication information: | Pathology 2024-07-09 | Abstract: | We describe the demographics, clinical and molecular epidemiology of extended-spectrum β-lactamase (ESBL) Escherichia coli bloodstream infections (BSI) in Central Australia. All ESBL-producing E. coli bloodstream isolates from January 2018 to December 2020 were retrospectively identified. Demographic and clinical information was extracted by chart review. Whole-genome sequencing was performed for multi-locus sequence typing, antibiotic-resistance genes, and phylogenetic relationships. We identified 41 non-duplicate episodes of ESBL E. coli BSI. Median age was 55 years (IQR 47-63), 78% were female, 93% were Aboriginal, and half came from a remote community. Infections were predominantly urinary (68%, 28/41). In the 12 months prior, 70% (26/37) of identified patients had been hospitalised and 81% (30/37) prescribed antibiotics. Meropenem and piperacillin-tazobactam susceptibility was maintained in 100% and 95% of isolates, respectively. Co-resistance to non-β-lactam antibiotics was 32% to gentamicin, 61% to trimethoprim/sulfamethoxazole, and 68% to ciprofloxacin. For sequenced isolates, 41% (16/35) were sequence type 131 (ST131). Mean acquired antibiotic-resistance genes for each isolate was 12.3 (SD 3.1). Four isolates carried an OXA-1 gene. Only non-ST131 isolates carried AmpC and acquired quinolone-resistance genes. There was some evidence of clustering of closely related strains, but no evidence of community or healthcare admission overlap. ESBL rates are rapidly rising in Central Australia, which is a conducive environment for antibiotic resistance development (e.g., overcrowding, socioeconomic disadvantages, high healthcare exposure and high antibiotic use). Future research is required to explore resistance-transmission dynamics in this unique setting. | URI: | https://ahro.austin.org.au/austinjspui/handle/1/35445 | DOI: | 10.1016/j.pathol.2024.04.013 | ORCID: | Journal: | Pathology | PubMed URL: | 39060195 | ISSN: | 1465-3931 | Type: | Journal Article | Subjects: | ESBL Escherichia coli bacteraemia epidemiology whole genome sequencing |
Appears in Collections: | Journal articles |
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