Background The management of urinary tract infections is complicatedby the increasing prevalence of antibiotic-resistant strainsof Escherichia coli. We studied the clonal composition of E.coli isolates that were resistant to trimethoprim–sulfamethoxazolefrom women with community-acquired urinary tract infections.
Methods Prospectively collected E. coli isolates from womenwith urinary tract infections in a university community in Californiawere evaluated for antibiotic susceptibility, O:H serotype,DNA fingerprinting, pulsed-field gel electrophoretic pattern,and virulence factors. The prevalence and characteristics ofan antibiotic-resistant clone were evaluated in this group ofisolates and in those from comparison cohorts in Michigan andMinnesota.
Results Fifty-five of the 255 E. coli isolates (22 percent)from the California cohort were resistant to trimethoprim–sulfamethoxazoleas well as other antibiotics. There was a common pattern ofDNA fingerprinting, suggesting that the isolates belonged tothe same clonal group (clonal group A), in 28 of 55 isolateswith trimethoprim–sulfamethoxazole resistance (51 percent)and in 2 of 50 randomly selected isolates that were susceptibleto trimethoprim–sulfamethoxazole (4 percent, P<0.001).In addition, 11 of 29 resistant isolates (38 percent) from theMichigan cohort and 7 of 18 (39 percent) from the Minnesotacohort belonged to clonal group A. Most of the clonal groupA isolates were serotype O11:H(nt) or O77:H(nt), with similarpatterns of virulence factors, antibiotic susceptibility, andelectrophoretic features.
Conclusions In three geographically diverse communities, a singleclonal group accounted for nearly half of community-acquiredurinary tract infections in women that were caused by E. colistrains with resistance to trimethoprim–sulfamethoxazole.The widespread distribution and high prevalence of E. coli clonalgroup A have major public health implications.
Source Information
From the Division of Epidemiology and Public Health Biology, School of Public Health, University of California at Berkeley, Berkeley (A.R.M., K.E.F., L.W.R.); the Medical Service, Minneapolis Veterans Affairs Medical Center, and the Department of Medicine, University of Minnesota, Minneapolis (J.R.J., T.T.O.); and the Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor (B.F.).
Address reprint requests to Dr. Riley at the Division of Epidemiology and Public Health Biology, School of Public Health, University of California, 140 Warren Hall, Berkeley, CA 94720, or at lwriley{at}uclink4.berkeley.edu.
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