Global Distribution of O Serotypes and Antibiotic Resistance in Extraintestinal Pathogenic Escherichia coli Collected From the Blood of Patients With Bacteremia Across Multiple Surveillance Studies

Eveline Weerdenburg; Todd Davies; Brian Morrow; Aldert L Zomer; Peter Hermans; Oscar Go; Bart Spiessens; Thijs van den Hoven; Gunter van Geet; Moussa Aitabi; Chitrita DebRoy; Edward G Dudley; Marc Bonten; Jan Poolman; Jeroen Geurtsen

doi:10.1093/cid/ciac421

Global Distribution of O Serotypes and Antibiotic Resistance in Extraintestinal Pathogenic Escherichia coli Collected From the Blood of Patients With Bacteremia Across Multiple Surveillance Studies

Clin Infect Dis. 2023 Feb 8;76(3):e1236-e1243. doi: 10.1093/cid/ciac421.

Authors

Affiliations

¹ Janssen Vaccines & Prevention, Leiden, the Netherlands.
² Janssen Research & Development, Raritan, New Jersey, USA.
³ Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
⁴ Janssen Research & Development, Beerse, Belgium.
⁵ Janssen Integrated Data Analytics & Reporting, Beerse, Belgium.
⁶ Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, Pennsylvania, USA.
⁷ Department of Food Science, E. coli Reference Center, Pennsylvania State University, University Park, Pennsylvania, USA.
⁸ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.

Abstract

Background: Extraintestinal pathogenic Escherichia coli (ExPEC) is the leading cause of bacteremia worldwide, with older populations having increased risk of invasive bacterial disease. Increasing resistance to first-line antibiotics and emergence of multidrug-resistant (MDR) strains represent major treatment challenges. ExPEC O serotypes are key targets for potential multivalent conjugate vaccine development. Therefore, we evaluated the O serotype distribution and antibiotic resistance profiles of ExPEC strains causing bloodstream infections across 4 regions.

Methods: Blood culture isolates from patients aged ≥60 years collected during 5 retrospective E. coli surveillance studies in Europe, North America, Asia-Pacific, and South America (2011-2017) were analyzed. Isolates were O serotyped by agglutination; O genotyping was performed for nontypeable isolates. Antimicrobial susceptibility testing was also conducted.

Results: Among 3217 ExPEC blood culture isolates, the most ubiquitous O serotype was O25 (n = 737 [22.9%]), followed by O2, O6, O1, O75, O15, O8, O16, O4, O18, O77 group, O153, O9, O101/O162, O86, and O13 (prevalence of ≥1%). The prevalence of these O serotypes was generally consistent across regions, apart from South America; together, these 16 O serotypes represented 77.6% of all ExPEC bacteremia isolates analyzed. The overall MDR frequency was 10.7%, with limited variation between regions. Within the MDR subset (n = 345), O25 showed a dominant prevalence of 63.2% (n = 218).

Conclusions: Predominant O serotypes among ExPEC bacteremia isolates are widespread across different regions. O25 was the most prevalent O serotype overall and particularly dominant among MDR isolates. These findings may inform the design of multivalent conjugate vaccines that can target the predominant O serotypes associated with invasive ExPEC disease in older adults.

Keywords: Escherichia coli; ExPEC; antibiotic resistance; multidrug resistance; serotype.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Bacteremia* / epidemiology
Drug Resistance, Microbial
Escherichia coli
Escherichia coli Infections* / epidemiology
Escherichia coli Infections* / microbiology
Extraintestinal Pathogenic Escherichia coli* / genetics
Humans
Retrospective Studies
Serogroup