Escherichia coli ST131 isolated from urological patients can acquire plasmid-mediated extended spectrum beta-lactamase from other bacteria with high frequency

Objectives: To investigate the prevalence of the clonal group Escherichia coli ST131 in urologic patients, and to clarify the mechanisms underlying the high prevalence of the antimicrobial resistant genes in ST131. Methods: We used 65 Escherichia coli strains collected from the Department of Urology, Nagasaki University Hospital, between January 2018 and December 2018. All of them underwent multilocus sequence typing and were analyzed for genes associated with quinolone resistance and extended-spectrum beta-lactamases. To compare ST131 and non-ST131 strains, bacterial conjugation experiments and intestinal colonization evaluations were performed. Results: ST131 was the most dominant among all the strains, along with levofloxacin resistant strains, and extended-spectrum beta-lactamases positive strains (32%, 63%, and 73%, respectively). 12 out of 15 extended-spectrum beta-lactamases-producing Escherichia coli strains harbored CTX-M-9. In particular, all extended-spectrum beta-lactamases-producing ST131 strains possessed CTX-M-9. The proportions of ST131 strains with or without quinolone resistance-determining region mutations were significantly higher and lower, respectively, than that of non-ST131 strains (P = 0.0002 and P < 0.0001, respectively). When Klebsiella pneumoniae was used as a donor, three ST131 strains acquired extended-spectrum beta-lactamases a total of 16 times (six, four, and six times each), which was significantly more than that in one of the non-ST131 strains (two times). The amount of bacteria was significantly lower in the ST131 strains than in the non-ST131 strains administered to mice. Both the ST131 and non-ST131 strains increased again after the administration of vancomycin, even after the colony was not detected. Conclusions: These results support the mechanisms underlying the prevalence of ST131 strains in hospitals, particularly in urologic patients.