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Infection (2011) 39:467471 DOI 10.1007/s15010-011-0128-2
BRIEF REPORT
Extended-spectrum b-lactamase-producing Escherichia coli strains in the feces of carriers contribute substantially to urinary tract infections in these patients
M. Niki I. Hirai A. Yoshinaga L. Ulzii-Orshikh
A. Nakata A. Yamamoto M. Yamamoto
Y. Yamamoto
Received: 21 December 2010 / Accepted: 31 May 2011 / Published online: 9 August 2011 Springer-Verlag 2011
AbstractIntroduction The current increase in the incidence of urinary tract infections (UTIs) worldwide caused by extended-spectrum b-lactamase (ESBL)-producing Escherichia coli may be due to the high number of ESBL-producing Enterobacteriaceae carriers in the community. However, whether ESBL-producing bacteria can cause UTIs in carriers remains uncertain.
Materials and methods In this study, 21 fecal carriers of ESBL-producing Enterobacteriaceae were assessed for UTIs caused by ESBL-producing E. coli. Bacterial isolates obtained from patients urine and stool specimens were phenotypically and genotypically examined. Clonal similarities of isolates were assessed by multilocus sequence typing (MLST) and random amplied polymorphic DNA (RAPD) ngerprinting.
Results The study revealed that 9 of 21 carriers developed UTIs, and genetic analysis showed that 44% of the UTIs developed were caused by the same ESBL-producingE. coli as that found in the feces of the patients.
Conclusions The ESBL-producing E. coli in carriers can cause UTIs.
Keywords Extended-spectrum b-lactamase Fecal
carriage Urinary tract infection Carrier
Introduction
Currently, the world is witnessing a dramatic increase in the prevalence of extended-spectrum b-lactamase (ESBL)-producing Enterobacteriaceae [13]. ESBLs are capable of inducing resistance against commonly recommended antimicrobial agents in the treatment of the infections [2]. Therefore, the increasing prevalence of ESBL-producingE. coli poses a serious problem in the treatment of nosocomial and community-acquired infections, including uri-nary tract infections (UTIs) [4]. UTIs are extremely common in health-care settings, particularly among elderly people. The most prevalent organisms isolated from patients with UTIs are E. coli and other Enterobacteriaceae species [5]. Current reports show a dramatic increase in the prevalence of ESBL-producing E. coli in patients with UTIs [2, 6]. However, the source or reservoir of these organisms in community settings is unclear. Our current study revealed that more than 50% of the healthy individuals from Thailand included in our study were carriers of ESBL-producing Enterobacteriaceae, which mainly consisted of E. coli [7]. Similarly, other studies have reported a high prevalence of ESBL-producing bacteria...