The contributions of multidrug resistant clones to the success of pandemic extra-intestinal Pathogenic Escherichia coli

ABSTRACT

Introduction

High-risk multidrug (MDR) clones have played essential roles in the global emergence and spread of antimicrobial resistance (AMR), especially among Extra-intestinal Escherichia coli (ExPEC).

Areas covered

Successful global ExPEC MDR clones are linked with the acquisition of fluoroquinolone resistance, CTX-M enzymes, and with carbapenemases. This article described the underlying mechanisms of fluoroquinolone resistance, the acquisition of CTX-M and carbapenemase genes among three global ExPEC high-risk MDR clones, namely i) ST1193 as being an example of a fluoroquinolone resistant clone. ii) ST131 as an example of a fluoroquinolone resistant and CTX-M clone. iii) ST410 as an example of a fluoroquinolone resistant, CTX-M and carbapenemase clone. This article also highlighted the contributions of these MDR determinants in the evolution of these high-risk MDR clones.

Expert opinion

There is an enormous public health burden due to E. coli MDR high-risk clones such as ST1193, ST131 and ST410. These clones have played pivotal roles in the global spread of AMR. Sparse information is available on which specific features of these high-risk MDR clones have enabled them to become such successful global pathogens in relative short time periods.

KEYWORDS:

• Carbapenemases
• CTX-M β-lactamases
• Extra-intestinal Escherichia coli
• Fluoroquinolone resistance
• Multidrug clones

Article highlights

• High-risk MDR clones are important reservoirs of AMR genes and have played essential roles in the global emergence, spread and subsequent increase of AMR over time.

• ExPEC is a leading cause of sepsis, hospitalization, and death across the world.

• Successful global ExPEC MDR clones (i.e. ST131, ST1193, ST405, ST38, ST648, ST410, ST167) are linked with fluoroquinolone resistance. Most of those clones (i.e. ST131, ST405, ST38, ST648, ST410, ST167) are also linked with CTX-M enzymes and some clones (i.e. ST410, ST131, ST167, ST405,) are also linked with carbapenemases.

• The stepwise acquisition of initial fluoroquinolone resistance (in the 1980s), then CTX-M genes (in the 1990s), followed by carbapenemase genes (in the 2000s), is shared between E. coli clones such as ST131, ST410 and K. pneumoniae MDR clones such as ST307 and ST147.

• ST131 is the greatest MDR high-risk global clone of all time and is a well-established fluoroquinolone-resistant and CTX-M E. coli clone.

• ST1193 appeared among fluoroquinolone resistant E. coli in the late 2000s and its prevalence has increased from 2012 onwards, following in the footsteps of ST131.

• ST410 is an emerging carbapenemase-producing global MDR E. coli clone that is linked with OXA-181 and NDM-5 and is frequent in lower-and-middle income countries.

• Sparse information is available on which specific features of ST131, ST1193, and ST410 have enabled them to become such successful global pathogens in a relatively short time period.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or mending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported by research grants from the JPIAMR/Canadian Institute Health Research program (#10016015).