Pitout JD. Extraintestinal pathogenic Escherichia coli: an update on antimicrobial resistance, laboratory diagnosis and treatment

Division of Microbiology, Calgary Laboratory Services, Calgary, Alberta, Canada and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada and Department of Microbiology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada. .
Expert Review of Anti-infective Therapy (Impact Factor: 3.46). 10/2012; 10(10):1165-76. DOI: 10.1586/eri.12.110
Source: PubMed


Escherichia coli remains one of the most frequent causes of nosocomial and community-acquired bacterial infections including urinary tract infections, enteric infections and systemic infections in humans. Extraintestinal pathogenic E. coli (ExPEC) had emerged during the 2000s as an important player in the resistance to antibiotics, especially to the cephalosporins and fluoroquinolones. Most importantly, among ExPEC is the increasing recognition of isolates producing 'newer β-lactamases' that consist of plasmid-mediated AmpC β-lactamases (e.g., CMY), extended-spectrum β-lactamases (e.g., CTX-M) and carbapenemases (e.g., New Delhi metallo-β-lactamase, Klebsiella pneumonaie carbapenemase and OXA-48). This review will highlight recent aspects on antimicrobial resistance in ExPEC, including the laboratory detection of these isolates, and describe some treatment options for infections due to antimicrobial-resistant isolates.

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    • "The problem of antibiotic resistance is also on the rise since women with frequent recurrent infections and symptoms can self-initiate a 3-day regimen of antibiotics therapy without consulting a physician. Due to the increasing resistance of uropathogenic bacteria to different antibiotics, carbapenems and ertapenem remain the last line of defense that requires cautious use and are reserved only to cases of recurrent UTI due to ESBL strains of uropathogenic E. coli [13]. "
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    ABSTRACT: Urinary tract infections (UTIs) are among the most common bacterial infections affecting women. UTIs are primarily caused by Escherichia coli, which increases the likelihood of a recurrent infection. We encountered two cases of recurrent UTIs (rUTIs) with a positive E. coli culture, not improving with antibiotics due to the development of antibiotic resistance. An alternative therapeutic regimen based on parsley and garlic, L-arginine, probiotics, and cranberry tablets has been given. This regimen showed a significant health improvement and symptoms relief without recurrence for more than 12 months. In conclusion, the case supports the concept of using alternative medicine in treating rUTI and as a prophylaxis or in patients who had developed antibiotic resistance.
    Case Reports in Medicine 12/2014; 2014. DOI:10.1155/2014/698758
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    • "Escherichia coli is a commensal bacterium generally found in the gastrointestinal tracts of humans and animals. Some strains can cause nosocomial and community-acquired infections including urinary tract, enteric and systemic post-surgical infections based on their virulence gene content (Pitout, 2012). Of particular concern are Extraintestinal Pathogenic E. coli (ExPEC). "
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    ABSTRACT: Extraintestinal Pathogenic Escherichia coli (ExPEC) have the potential to spread through fecal waste resulting in the contamination of both farm workers and retail poultry meat in the processing plants or environment. The objective of this study was to characterize ExPEC from retail poultry meats purchased from Alberta, Canada and to compare them with 12 human ExPEC representatives from major ExPEC lineages. Fifty-four virulence genes were screened by a set of multiplex PCRs in 700 E. coli from retail poultry meat samples. ExPEC was defined as the detection of at least two of the following virulence genes: papA/papC, sfa, kpsMT II and iutA. Genetic relationships between isolates were determined using pulsed field gel electrophoresis (PFGE). Fifty-nine (8.4%) of the 700 poultry meat isolates were identified as ExPEC and were equally distributed among the phylogenetic groups A, B1, B2 and D. Isolates of phylogenetic group A possessed up to 12 virulence genes compared to 24 and 18 genes in phylogenetic groups B2 and D, respectively. E. coli identified as ExPEC and recovered from poultry harbored as many virulence genes as those of human isolates. In addition to the iutA gene, siderophore-related iroN and fyuA were detected in combination with other virulence genes including those genes encoding for adhesion, protectin and toxin while the fimH, ompT, traT, uidA and vat were commonly detected in poultry ExPEC. The hemF, iss and cvaC genes were found in 40% of poultry ExPEC. All human ExPEC isolates harbored concnf (cytotoxic necrotizing factor 1 altering cytoskeleton and causing necrosis) and hlyD (hemolysin transport) genes which were not found in poultry ExPEC. PFGE analysis showed that a few poultry ExPEC isolates clustered with human ExPEC isolates at 55–70% similarity level. Comparing ExPEC isolated from retail poultry meats provides insight into their virulence potential and suggests that poultry associated ExPEC may be important for retail meat safety. Investigations into the ability of our poultry ExPEC to cause human infections are warranted.
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    ABSTRACT: Acute cystitis is one of the most commonly encountered bacterial infections, and is responsible for substantial morbidity and high medical costs in the United States and across the globe. Though often thought to be self-limiting and easily treated by antibiotics, urinary tract infections (UTIs) are often incompletely resolved by antibiotic therapy and frequently recur. This is in part due to the ability of uropathogenic bacteria to invade, replicate, and persist within host epithelial cells. The biological complexity of these infections combined with a dramatic rise in antibiotic resistant pathogens highlight the need for alternative therapies. In this review we will examine current management strategies for UTIs, as well as emerging treatments, including novel compounds that block bacterial interactions with the urothelium and vaccines focused on preventing both acute and recurrent infections.
    Clinical Infectious Diseases 05/2013; 57(5). DOI:10.1093/cid/cit284 · 8.89 Impact Factor
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