Downloaded from www.microbiologyresearch.org by IP: 54.70.40.11 On: Thu, 25 Oct 2018 21:50:22 Low intestinal colonization of Escherichia coli clone ST131 producing CTX-M-15 in Jordanian infants E. F. Badran, 1 R. A. Qamer Din 2 and A. A. Shehabi 2 Correspondence A. A. Shehabi ashehabi@ju.edu.jo 1 Department of Pediatrics, Faculty of Medicine, University of Jordan, Amman, Jordan 2 Department of Pathology-Microbiology, Faculty of Medicine, University of Jordan, Amman, Jordan Over a period of 3 years’ study (2012–2014), a total of 518 faecal samples were collected and cultured to isolate Escherichia coli. Of these, 338 (65.3 %) E. coli isolates were recovered from infants, and 142/338 (42 %) were multidrug-resistant (MDR) to $3 drug classes using the antimicrobial susceptibility disc diffusion method. A total of 125/142 (88 %) of E. coli isolates were extended-spectrum b-lactamase (ESBL) producers. blaCTX-M-15 types were observed in 80/125 (64 %) of the isolates, and 60/80 (75 %) were positive for blaCTX-M-15. Out of 338 E. coli isolates, 9 (2.6 %) were positive for ST131/O25b clone and each isolate was associated with several plasmids of different sizes (1–21.2 kb). The identities of these nine isolates were confirmed by sequencing for presence of pabB (347 bp) and trpA (427 bp) genes. This study demonstrates low prevalence rate of the highly virulent E. coli ST131 clone producing blaCTX-M-15 in the intestines of Jordanian infants. Received 9 September 2015 Accepted 17 December 2015 INTRODUCTION Recently, Escherichia coli ST131 clone has been isolated from a diverse range of infections caused in community and hospitalized patients across the world (Dahbi et al., 2014; Papagiannitsis et al., 2015; Peirano et al., 2014; Wu et al., 2014). A recent French study showed the proportion of E. coli ST131 as an intestinal colonizing organism increased significantly over time, from 8 % in 2002 to 50 % in 2004 (Han et al., 2014). The pandemic spread of this clone around the world since 2000 was recognized by utilizing multilocus sequence typing (MLST) of CTX- M-15 extended-spectrum b-lactamase (ESBL)-producing E. coli strains from three different continents (Rogers et al., 2011). A study from Egypt indicated that 75 % of clinical CTX-M-15-producing E. coli group B2 isolates belonged to clone ST131 (Fam et al., 2011). Recent studies also reported high prevalence rates of faecal E. coli ST131 among fluoroquinolone-resistant isolates in geriatric patients and residents of long-term care facilities (Burgess et al., 2015; Dahbi et al., 2014; Ho et al., 2015). E. coli ST131 causes a wide variety of infections ranging from cystitis to life-threatening sepsis. Fluoroquinolones and trimethoprim-sulfamethoxazole are no longer effective for empiric therapy of infections caused by this clone (Can et al., 2015; Qureshi & Doi, 2014). The rapid global emergence of E. coli ST131 clone produ- cing blaCTX-M-15 is explained by carrying a broad range of distinct virulence factor and resistance genes on a transferable plasmid, especially its acquisition of fluoroqui- nolone resistance genes (Can et al., 2015; Petty et al., 2014). In addition, this clone has also been detected in domestic and wild animals, and foods (Rogers et al., 2011). However, there are still limited data on geographical distribution of this clone or intestinal colonization with multidrug-resist- ant (MDR) E. coli in Middle East countries and elsewhere (Dashti et al., 2014; Fam et al., 2011). Generally, intestinal colonization of infants with MDR E. coli strains should be considered an alarming risk factor for possible develop- ment of serious infection in the future, and it would reflect the status of antimicrobial resistance in the community (Petty et al., 2014). This study investigated the colonizing rate of E. coli ST131 clone producing CTX-M-15 in the intestines of Jordanian infants. METHODS Study design and population. This prospective convenience sampling study included 518 infants v1 year of age, who were investigated at the Paediatric Department, The Jordan University Hospital, Amman, Jordan, from July 2012 through March 2015. Biographical data of each infant were obtained and recorded on special forms as part of routine clinical investigation. The form included age, gender, name, duration of hospitalization, disease history, and antibiotics being taken at the time of sampling. Ethical Abbreviations: ESBL, extended-spectrum b-lactamase; MDR, multidrug-resistant. Journal of Medical Microbiology (2016), 65, 137–141 DOI 10.1099/jmm.0.000210 000210 G 2015 The Authors Printed in Great Britain 137