Diversity of carbapenemase-producing Escherichia coli isolates, France 2012-2013 [PublishAheadOfPrint]

With the dissemination of carbapenemase-producing Enterobacteriaceae (CPE) worldwide, carbapenem-hydrolyzing enzymes are increasingly reported among Escherichia coli, the first hospital and community-acquired opportunistic pathogen. Here, we have performed an epidemiological survey of carbapenemase-producing E. coli (CP-Ec) isolates received at the French National Reference Centre (F-NRC) in 2012 and 2013. Antimicrobial susceptibilities for last resort antibiotics and antimicrobial compounds commonly used to treat urinary tract infections were determined by broth microdilution. Clonal relationship was assessed using rep-PCR and MLST typing. From this collection of 140 carbapenemase-producing E. coli, (74%) produced an OXA-48-like carbapenemase followed by NDM (21%). A link with a foreign country was suspected for 37% of infected/colonized patients. Most of the isolates were from screening (56%) and from urine samples (26%). Colistin, fosfomycin and nitrofurantoin possessed the most consistent activity with 100%, 95% and 96% of susceptibility, respectively. A wide diversity of carbapenemase-producing E. coli isolates has been found (50 different STs). The most prevalent clones were (i) E. coli ST38 producing-OXA-48 (n=21), a clone related to Turkey and North African countries, (ii) E. coli ST-90 producing OXA-204 (n=9), which was responsible of an outbreak related to a contaminated duodenoscope, and (iii) E. coli ST-410 producing OXA-181 (n=5) recovered from patients of different geographical origin. These specific clones might be considered high-risk clones for the dissemination of carbapenemases in E. coli. The wide diversity of STs combined with the increasing number of CP-Ec isolates received by the F-NRC suggests a likely dissemination of CP-Ec isolates in the community.

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