Prevalence and risk factors for colonization by extended-spectrum β-lactamase-producing or ST 131 Escherichia coli among asymptomatic adults in community settings in Southern Taiwan

Pin-Chieh Wu; Jiun-Ling Wang; Po-Ren Hsueh; Po-Hsiang Lin; Ming-Fang Cheng; I-Fei Huang; Yao-Shen Chen; Susan Shin-Jung Lee; Mar Guang-Yuan; Hsien-Chung Yu; Chiao-Lin Hsu; Fu-Wei Wang; Chi-Shen Chen; Chih-Hsin Hung; Wen-Chien Ko

doi:10.2147/IDR.S201086

Prevalence and risk factors for colonization by extended-spectrum β-lactamase-producing or ST 131 Escherichia coli among asymptomatic adults in community settings in Southern Taiwan

Infect Drug Resist. 2019 May 3:12:1063-1071. doi: 10.2147/IDR.S201086. eCollection 2019.

Authors

Pin-Chieh Wu^{1

2}, Jiun-Ling Wang^{3

4}, Po-Ren Hsueh⁵, Po-Hsiang Lin⁶, Ming-Fang Cheng^{7

8

9

10}, I-Fei Huang⁷, Yao-Shen Chen^{8

11}, Susan Shin-Jung Lee^{8

11}, Mar Guang-Yuan^{1

11}, Hsien-Chung Yu^{1

8

11

12}, Chiao-Lin Hsu^{1

2}, Fu-Wei Wang^{2

13}, Chi-Shen Chen¹, Chih-Hsin Hung⁹, Wen-Chien Ko^{3

4}

Affiliations

¹ Department of Physical Examination Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
² Department of Nursing, Meiho University, Pingtung, Taiwan.
³ Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
⁴ Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁵ Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
⁶ Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁷ Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁸ School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁹ Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan.
¹⁰ Department of Nursing, Fooyin University, Kaohsiung, Taiwan.
¹¹ Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
¹² Institute of Health Care Management, Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan.
¹³ Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.

Abstract

Purpose: Fecal carriage of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is common in Asia, especially in China and Southeast Asia. There are no data about fecal carriage of ESBL-EC and mcr-1-positive E. coli in Taiwan, and few studies focusing on the risk factors of asymptomatic fecal carriage of epidemic ST131 E. coli have been published. Patients and methods: From healthy inhabitants attending health examinations at a medical center in southern Taiwan in 2017, we collected 724 stool samples, which were examined for ESBL-EC fecal carriage using chromogenic medium. ST131 and mcr1-positive E. coli were also investigated using multiplex PCR. Clinical data from all participating adults were collected to analyze the risk factors for fecal ESBL-EC or ST131 E. coli carriage. Results: The prevalence rate of asymptomatic ESBL-EC fecal carriage in adults was 1.9% (14/724). ST131 was found in 22 (3.0%) adults and mcr-1-positive E. coli was found in three (0.4%) adults. A multivariate analysis showed that the risk factors associated with ESBL-EC carriage were diabetes mellitus (adjusted odds ratio [aOR]: 5.5, 95% confidence interval [CI]: 1.3-22.7), a history of colonic polyps (aOR: 6.4, 95% CI: 1.6-24.9), and chronic renal insufficiency (aOR: 20.7, 95% CI: 1.4-305.7). Underlying cancer (aOR: 4.8, 95% CI: 1.0-22.5) and stroke (aOR: 18.0, 95% CI: 1.6-207.5) were associated with ST131 E. coli fecal carriage. In our cohort, travel to Asian countries and food habit were not associated with ST131 or ESBL-EC fecal carriage. Conclusions: The ESBL-EC or ST131 E. coli fecal carriage rate is low among asymptomatic adults in Taiwan. Certain underlying medical conditions were associated with their fecal carriage.

Keywords: Escherichia coli; MCR1; extended-spectrum β-lactamase; fecal colonization; sequence type.