Prevalence and Antimicrobial Resistance Patterns of Diarrheagenic Escherichia coli in Shanghai, China.

BACKGROUND: Diarrheagenic Escherichia coli (DEC) is a major cause of bacterial gastroenteritis in children. Also, antibiotic resistance among DEC is becoming a critical area of concern in clinical settings. METHODS: This study was conducted in 4 hospitals in Shanghai from June 2012 to October 2013. DEC isolates from stool samples of patients with diarrhea were examined to determine their antimicrobial susceptibilities and presence of virulence genes, in order to identify high risk clones. RESULTS: A total of 735 (10.2%) DEC isolates were identified from 7204 stool samples from patients with diarrhea, including 374 enteropathogenic E. coli, 318 enterotoxigenic E. coli, 36 Shigella/enteroinvasive E. coli and 7 Shiga toxin-producing E. coli (STEC). Among the 735 DEC isolates, 299 (40.7%) were isolated from children less than 5 years old. High resistance rates were observed to streptomycin (90.7%), ampicillin (63.4%), nalidixic acid (61.1%), sulfisoxazole (49.1%), tetracycline (41.2%), trimethoprim (35.6%), trimethoprim-sulfamethoxazole (35.4%), followed by amoxicillin-clavulanic acid (27.2%), cefotaxime (24.5%), cefepime (23.5%), gentamicin (16.7%), ceftazidime (12.4%), chloramphenicol (10.6%), ciprofloxacin (7.2%) and ofloxacin (3.4%). All the isolates were susceptible to imipenem. In addition, potential virulence genes were screened by polymerase chain reaction. A total of 15 enterotoxigenic E. coli belonging to the same clone were identified to be associated with nosocomial neonatal diarrhea and resistant to greater than 10 antimicrobials. CONCLUSION: Our findings suggest that active surveillance programs combining both phenotypic and genetic data would help identify disease outbreaks and strengthen antibiotic management.

RNA-Based Detection Does not Accurately Enumerate Living Escherichia coli O157:H7 Cells on Plants.

The capacity to distinguish between living and dead cells is an important, but often unrealized, attribute of rapid detection methods for foodborne pathogens. In this study, the numbers of enterohemorrhagic Escherichia coli O157:H7 after inoculation onto Romaine lettuce plants and on plastic (abiotic) surfaces were measured over time by culturing, and quantitative PCR (qPCR), propidium monoazide (PMA)-qPCR, and reverse transcriptase (RT)-qPCR targeting E. coli O157:H7 gapA, rfbE, eae, and lpfA genes and gene transcripts. On Romaine lettuce plants incubated at low relative humidity, E. coli O157:H7 cell numbers declined 10(7)-fold within 96 h according to culture-based assessments. In contrast, there were no reductions in E. coli levels according to qPCR and only 100- and 1000-fold lower numbers per leaf by RT-qPCR and PMA-qPCR, respectively. Similar results were obtained upon exposure of E. coli O157:H7 to desiccation conditions on a sterile plastic surface. Subsequent investigation of mixtures of living and dead E. coli O157:H7 cells strongly indicated that PMA-qPCR detection was subject to false-positive enumerations of viable targets when in the presence of 100-fold higher numbers of dead cells. RT-qPCR measurements of killed E. coli O157:H7 as well as for RNaseA-treated E. coli RNA confirmed that transcripts from dead cells and highly degraded RNA were also amplified by RT-qPCR. These findings show that neither PMA-qPCR nor RT-qPCR provide accurate estimates of bacterial viability in environments where growth and survival is limited.

Virulence characterization of non-O157 Shiga toxin-producing Escherichia coli isolates from food, humans and animals.

A total of 359 non-O157 STEC isolates from food, humans and animals were examined for serotypes, Shiga toxin subtypes and intimin subtypes. Isolates solely harboring stx2 from the three sources were selected for Vero cell cytotoxicity test. stx subtypes in eae negative isolates were more diverse than in eae positive isolates primarily carrying stx2a. Four eae subtypes (eaeß,eaeε1,eaeγ1 and eaeγ2/θ) were observed and correlated with serotypes and flagella. Food isolates showed more diverse serotypes, virulence factors and cell cytotoxicities than human isolates. Some isolates from produce belonged to serotypes that have been implicated in human diseases, carried stx2a or/and stx2dact and exhibited high cell cytotoxicity similar to human isolates. This indicates that foods can be contaminated with potentially pathogenic STEC isolates that may cause human diseases. Given the increased produce consumption and growing burden of foodborne outbreaks due to produce, produce safety should be given great importance.

Genomic diversity and virulence profiles of historical Escherichia coli O157 strains isolated from clinical and environmental sources.

Escherichia coli O157:H7 is, to date, the major E. coli serotype causing food-borne human disease worldwide. Strains of O157 with other H antigens also have been recovered. We analyzed a collection of historic O157 strains (n = 400) isolated in the late 1980s to early 1990s in the United States. Strains were predominantly serotype O157:H7 (55%), and various O157:non-H7 (41%) serotypes were not previously reported regarding their pathogenic potential. Although lacking Shiga toxin (stx) and eae genes, serotypes O157:H1, O157:H2, O157:H11, O157:H42, and O157:H43 carried several virulence factors (iha, terD, and hlyA) also found in virulent serotype E. coli O157:H7. Pulsed-field gel electrophoresis (PFGE) showed the O157 serogroup was diverse, with strains with the same H type clustering together closely. Among non-H7 isolates, serotype O157:H43 was highly prevalent (65%) and carried important enterohemorrhagic E. coli (EHEC) virulence markers (iha, terD, hlyA, and espP). Isolates from two particular H types, H2 and H11, among the most commonly found non-O157 EHEC serotypes (O26:H11, O111:H11, O103:H2/H11, and O45:H2), unexpectedly clustered more closely with O157:H7 than other H types and carried several virulence genes. This suggests an early divergence of the O157 serogroup to clades with different pathogenic potentials. The appearance of important EHEC virulence markers in closely related H types suggests their virulence potential and suggests further monitoring of those serotypes not implicated in severe illness thus far.

Molecular analysis and antimicrobial susceptibility of enterotoxigenic Escherichia coli from diarrheal patients.

A total of 123 enterotoxigenic Escherichia coli (ETEC) isolates from diarrheal patients from June to December 2012 in Shanghai, China, were examined to determine their genetic relatedness using multilocus sequence typing and pulsed-field gel electrophoresis (PFGE) and for the presence of virulence genes and antimicrobial susceptibility. Twenty-nine sequence types (STs) and 63 PFGE patterns were identified, and results from the 2 subtyping methods correlated well. The 12 isolates of PFGE cluster B all belonged to ST-2332 and were associated with nosocomial neonatal diarrhea. Isolates of a cluster usually had the same set of virulence factors, whereas isolates of different PFGE clusters carried diverse combinations of virulence determinants. Isolates belonging to ST-2332 and ST-182 (n=9) were resistant to at least 6 antimicrobials. Our findings highlighted the need of active surveillance programs for infectious diseases collecting data at both epidemiological and genetic levels that can detect high-risk lineages of pathogens in order to rapidly identify disease outbreaks.

Pathogenicity islands in Shiga toxin-producing Escherichia coli O26, O103, and O111 isolates from humans and animals.

Non-O157 Shiga toxin-producing Escherichia coli (STEC) are increasingly recognized as foodborne pathogens worldwide. Serogroups O26, O111, and O103 cause most known outbreaks related to non-O157 STEC. Pathogenicity islands (PAIs) play a major role in the evolution of STEC pathogenicity. To determine the distribution of PAIs often associated with highly virulent STECs (OI-122, OI-43/48, OI-57, and high pathogenicity islands) among STEC O26, O103, and O111, a collection of STEC O26 (n=45), O103 (n=29), and O111 (n=52) from humans and animals were included in this study. Pulsed-field gel electrophoresis (PFGE) with XbaI digestion was used to characterize the clonal relationship of the strains. In addition, a polymerase chain reaction-restriction fragment length polymorphism assay was used to determine eae subtypes. Additional virulence genes on PAIs were identified using specific PCR assays, including OI-122: pagC, sen, efa-1, efa-2, and nleB; OI-43/48: terC, ureC, iha, and aidA-1; OI-57: nleG2-3, nleG5-2, and nleG6-2; and HPI: fyuA and irp2. A PFGE dendrogram demonstrated that instead of clustering together with strains from the same O type (O111:H8), the O111:H11 (n=14) strains clustered together with strains of the same H type (O26:H11, n=45). In addition, O26:H11 and O111:H11 strains carried eae subtype ß, whereas O111:H8 strains had eae γ2/θ. The O26:H11 and O111:H11 stains contained an incomplete OI-122 lacking pagC and a complete HPI. However, a complete OI-122 but no HPI was found in the O111:H8 strains. Additionally, aidA-1 of OI-43/48 and nleG6-2 of OI-57 were significantly associated with O26:H11 and O111:H11 strains but were almost missing in O111:H8 strains (p<0.001). This study demonstrated that H11 (O111:H11 and O26:H11) strains were closely related and may have come from the same ancestor.

Association of clustered regularly interspaced short palindromic repeat (CRISPR) elements with specific serotypes and virulence potential of shiga toxin-producing Escherichia coli.

Shiga toxin-producing Escherichia coli (STEC) strains (n = 194) representing 43 serotypes and E. coli K-12 were examined for clustered regularly interspaced short palindromic repeat (CRISPR) arrays to study genetic relatedness among STEC serotypes. A subset of the strains (n = 81) was further analyzed for subtype I-E cas and virulence genes to determine a possible association of CRISPR elements with potential virulence. Four types of CRISPR arrays were identified. CRISPR1 and CRISPR2 were present in all strains tested; 1 strain also had both CRISPR3 and CRISPR4, whereas 193 strains displayed a short, combined array, CRISPR3-4. A total of 3,353 spacers were identified, representing 528 distinct spacers. The average length of a spacer was 32 bp. Approximately one-half of the spacers (54%) were unique and found mostly in strains of less common serotypes. Overall, CRISPR spacer contents correlated well with STEC serotypes, and identical arrays were shared between strains with the same H type (O26:H11, O103:H11, and O111:H11). There was no association identified between the presence of subtype I-E cas and virulence genes, but the total number of spacers had a negative correlation with potential pathogenicity (P < 0.05). Fewer spacers were found in strains that had a greater probability of causing outbreaks and disease than in those with lower virulence potential (P < 0.05). The relationship between the CRISPR-cas system and potential virulence needs to be determined on a broader scale, and the biological link will need to be established.

Genome Sequences of Two Emerging Non-O157 Shiga Toxin-Producing Escherichia coli Strains.

Shiga toxin-producing Escherichia coli (STEC) causes severe illness in humans, including hemorrhagic colitis and hemolytic uremic syndrome. A parallel evolutionary model was proposed in which E. coli strains of distinct phylogenies independently integrate Shiga toxin-encoding genes and evolve into STEC. We report the draft genomes of two emerging non-O157 STEC strains.

Molecular serogrouping of Shiga toxin-producing Escherichia coli using suspension array.

A suspension array assay was developed for molecular serotyping of the seven most prevalent Shiga toxin-producing Escherichia coli (STEC) serogroups (O26, O45, O103, O111, O121, O145, and O157). Fluorescence values of 59 STEC were 30 to >270 times greater than the signals of negative controls, demonstrating the method's effectiveness for the molecular serotyping of STEC.

Distribution of pathogenicity islands OI-122, OI-43/48, and OI-57 and a high-pathogenicity island in Shiga toxin-producing Escherichia coli.

Pathogenicity islands (PAIs) play an important role in Shiga toxin-producing Escherichia coli (STEC) pathogenicity. The distribution of PAIs OI-122, OI-43/48, and OI-57 and a high-pathogenicity island (HPI) were determined among 98 STEC strains assigned to seropathotypes (SPTs) A to E. PCR and PCR-restriction fragment length polymorphism assays were used to identify 14 virulence genes that belonged to the four PAIs and to subtype eae and stx genes, respectively. Phylogenetic trees were constructed based on the sequences of pagC among 34 STEC strains and iha among 67 diverse pathogenic E. coli, respectively. Statistical analysis demonstrated that the prevalences of OI-122 (55.82%) and OI-57 (82.35%) were significantly greater in SPTs (i.e., SPTs A, B, and C) that are frequently associated with severe disease than in other SPTs. terC (62.5%) and ureC (62.5%) in OI-43/48 were also significantly more prevalent in SPTs A, B, and C than in SPTs D and E. In addition, OI-122, OI-57, and OI-43/48 and their associated virulence genes (except iha) were found to be primarily associated with eae-positive STEC, whereas HPI occurred independently of the eae presence. The strong association of OI-122, OI-43/48, and OI-57 with eae-positive STEC suggests in part that different pathogenic mechanisms exist between eae-positive and eae-negative STEC strains. Virulence genes in PAIs that are associated with severe diseases can be used as potential markers to aid in identifying highly virulent STEC.

Phylogenetic analysis of non-O157 Shiga toxin-producing Escherichia coli strains by whole-genome sequencing.

Non-O157 Shiga toxin-producing Escherichia coli (STEC) strains are emerging food-borne pathogens causing life-threatening diseases and food-borne outbreaks. A better understanding of their evolution provides a framework for developing tools to control food safety. We obtained 15 genomes of non-O157 STEC strains, including O26, O111, and O103 strains. Phylogenetic trees revealed a close relationship between O26:H11 and O111:H11 and a scattered distribution of O111. We hypothesize that STEC serotypes with the same H antigens might share common ancestors.

Non-O157 Shiga toxin-producing Escherichia coli in retail ground beef and pork in the Washington D.C. area.

The prevalence and characteristics of non-O157 Shiga toxin-producing Escherichia coli (STEC) in retail ground meat from the Washington D.C. area were investigated in this study. STEC from 480 ground beef and pork samples were identified using PCR screening followed by colony hybridization. The STEC isolates were serogrouped and examined for the presence of virulence genes (stx1, stx2, eae and hlyA), and antimicrobial susceptibility. PFGE was used to identify the clonal relationships of STEC isolates, and PCR-RFLP was employed to determine stx subtypes. In addition, the cytotoxicity of STEC isolates was determined using a Vero cell assay. STEC were identified in 12 (5.2%) of 231 ground pork and 13 (5.2%) of 249 ground beef samples. Among 32 STEC isolates recovered from the 25 samples, 12 (37.5%) carried stx2dact and 7 (21.9%) carried hlyA, but none carried eae. Nine isolates were identified as O91, and 17 (53.1%) isolates were resistant to two or more antimicrobials. Verotoxicity was detected in 26 (81.3%) of the STEC isolates. Thus, the retail ground meat was contaminated with a heterogeneous population of non-O157 STEC, some of which were potential human pathogens.