Uropathogenic Escherichia coli population structure and antimicrobial susceptibility in Norfolk, UK.

Carter C, Hutchison A, Rudder S, Trotter E, Waters EV, Elumogo N, Langridge G. (2023)

The Journal of antimicrobial chemotherapy

Background: Urinary tract infections are a frequent cause for visits to primary care providers. In alignment globally, Uropathogenic E. coli (UPEC) are the main etiological agent for UTIs in Norfolk and are increasingly difficult to treat due to multi-drug resistance (MDR).

Objective: We set out to identify which clonal groups and resistance genes are disseminating in the community and hospitals in Norfolk, the first study of its kind for UPEC in this region.

Methods: We collected 199 clinical E. coli isolates causing UTIs in the community and hospital from the Clinical Microbiology laboratory at Norfolk and Norwich University Hospital between August 2021 and January 2022. These were whole genome sequenced using the Illumina and MinION platforms for in silico multi-locus sequence typing and antibiotic resistance determinant detection.

Results: The isolates were composed of 70 sequence types (STs); 8 lineages represented 56.7% of this population: ST73, ST12, ST69, ST131, ST404, ST95, ST127, and ST1193. Importantly, primary UTI screening deemed 6.5% of isolates to be MDR, with high rates of resistance to ampicillin (52.1%) and trimethoprim (36.2%) in hospitals. Of concern is the probable clonal expansion of MDR groups ST131 and ST1193 in hospitals and community settings with chromosomally encoded bla_CTX-M-15, bla_OXA-1, and aac(6)-Ib-cr5.

Conclusions: The burden of reported UTIs in Norfolk is largely caused by non-MDR isolates and mirrors similar UPEC studies nationally and internationally. Continually monitoring samples with consideration of sources will help reduce burden of disease.

The Journal of antimicrobial chemotherapy

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