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Research

Emerging antimicrobial resistance among Escherichia coli strains in bloodstream infections in Toronto, 2006–2016: a retrospective cohort study

Sophie Mineau, Robert Kozak, Melissa Kissoon, Aimee Paterson, Anthony Oppedisano, Firas Douri, Kate Gogan, Barbara M. Willey, Allison McGeer and Susan M. Poutanen
December 03, 2018 6 (4) E580-E586; DOI: https://doi.org/10.9778/cmajo.20180039
Sophie Mineau
Department of Microbiology (Mineau, Kozak, Kissoon, Paterson, Oppedisano, Douri, Gogan, Willey, McGeer, Poutanen), University Health Network/Sinai Health System, Toronto, Ont.; Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Mineau), Sainte-Marie, Que.; Lawrence Park Collegiate Institute (Gogan); Departments of Laboratory Medicine and Pathobiology and of Medicine (McGeer, Poutanen), University of Toronto, Toronto, Ont.
MD
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Robert Kozak
Department of Microbiology (Mineau, Kozak, Kissoon, Paterson, Oppedisano, Douri, Gogan, Willey, McGeer, Poutanen), University Health Network/Sinai Health System, Toronto, Ont.; Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Mineau), Sainte-Marie, Que.; Lawrence Park Collegiate Institute (Gogan); Departments of Laboratory Medicine and Pathobiology and of Medicine (McGeer, Poutanen), University of Toronto, Toronto, Ont.
PhD
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Melissa Kissoon
Department of Microbiology (Mineau, Kozak, Kissoon, Paterson, Oppedisano, Douri, Gogan, Willey, McGeer, Poutanen), University Health Network/Sinai Health System, Toronto, Ont.; Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Mineau), Sainte-Marie, Que.; Lawrence Park Collegiate Institute (Gogan); Departments of Laboratory Medicine and Pathobiology and of Medicine (McGeer, Poutanen), University of Toronto, Toronto, Ont.
BSc
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Aimee Paterson
Department of Microbiology (Mineau, Kozak, Kissoon, Paterson, Oppedisano, Douri, Gogan, Willey, McGeer, Poutanen), University Health Network/Sinai Health System, Toronto, Ont.; Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Mineau), Sainte-Marie, Que.; Lawrence Park Collegiate Institute (Gogan); Departments of Laboratory Medicine and Pathobiology and of Medicine (McGeer, Poutanen), University of Toronto, Toronto, Ont.
MSc
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Anthony Oppedisano
Department of Microbiology (Mineau, Kozak, Kissoon, Paterson, Oppedisano, Douri, Gogan, Willey, McGeer, Poutanen), University Health Network/Sinai Health System, Toronto, Ont.; Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Mineau), Sainte-Marie, Que.; Lawrence Park Collegiate Institute (Gogan); Departments of Laboratory Medicine and Pathobiology and of Medicine (McGeer, Poutanen), University of Toronto, Toronto, Ont.
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Firas Douri
Department of Microbiology (Mineau, Kozak, Kissoon, Paterson, Oppedisano, Douri, Gogan, Willey, McGeer, Poutanen), University Health Network/Sinai Health System, Toronto, Ont.; Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Mineau), Sainte-Marie, Que.; Lawrence Park Collegiate Institute (Gogan); Departments of Laboratory Medicine and Pathobiology and of Medicine (McGeer, Poutanen), University of Toronto, Toronto, Ont.
MSc
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Kate Gogan
Department of Microbiology (Mineau, Kozak, Kissoon, Paterson, Oppedisano, Douri, Gogan, Willey, McGeer, Poutanen), University Health Network/Sinai Health System, Toronto, Ont.; Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Mineau), Sainte-Marie, Que.; Lawrence Park Collegiate Institute (Gogan); Departments of Laboratory Medicine and Pathobiology and of Medicine (McGeer, Poutanen), University of Toronto, Toronto, Ont.
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Barbara M. Willey
Department of Microbiology (Mineau, Kozak, Kissoon, Paterson, Oppedisano, Douri, Gogan, Willey, McGeer, Poutanen), University Health Network/Sinai Health System, Toronto, Ont.; Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Mineau), Sainte-Marie, Que.; Lawrence Park Collegiate Institute (Gogan); Departments of Laboratory Medicine and Pathobiology and of Medicine (McGeer, Poutanen), University of Toronto, Toronto, Ont.
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Allison McGeer
Department of Microbiology (Mineau, Kozak, Kissoon, Paterson, Oppedisano, Douri, Gogan, Willey, McGeer, Poutanen), University Health Network/Sinai Health System, Toronto, Ont.; Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Mineau), Sainte-Marie, Que.; Lawrence Park Collegiate Institute (Gogan); Departments of Laboratory Medicine and Pathobiology and of Medicine (McGeer, Poutanen), University of Toronto, Toronto, Ont.
MD MSc
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Susan M. Poutanen
Department of Microbiology (Mineau, Kozak, Kissoon, Paterson, Oppedisano, Douri, Gogan, Willey, McGeer, Poutanen), University Health Network/Sinai Health System, Toronto, Ont.; Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Mineau), Sainte-Marie, Que.; Lawrence Park Collegiate Institute (Gogan); Departments of Laboratory Medicine and Pathobiology and of Medicine (McGeer, Poutanen), University of Toronto, Toronto, Ont.
MD MPH
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    Figure 1:

    Proportion of Escherichia coli and Klebsiella pneumoniae blood culture isolates that produced extended-spectrum β-lactamase (ESBL), altogether and in intensive care units (ICUs) and emergency departments (EDs), and proportion of ST131 clonal type within E. coli isolates that produced ESBL, 2006–2016.

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    Figure 2:

    Antimicrobial susceptibilities of Escherichia coli blood culture isolates, 2006–2016. (A): Extended-spectrum β-lactamase (ESBL) producers and non–ESBL-producers combined. (B): Non–ESBL-producers and ESBL producers separately.

Tables

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    Table 1:

    Proportion of Escherichia coli, Klebsiella pneumoniae, K. oxytoca and Proteus mirabilis blood culture isolates that produced extended-spectrum β-lactamase, including proportion of ST131 clonal type within E. coli isolates that produced extended-spectrum β-lactamase, 2006–2016

    OrganismYear; no. (%) of isolatesp value*
    20062007200820092010201120122013201420152016
    Escherichia coli19/296 (6.4)13/309 (4.2)29/355 (8.2)28/376 (7.4)33/394 (8.4)51/428 (11.9)58/457 (12.7)81/485 (16.7)65/485 (13.4)76/516 (14.7)89/513 (17.3)< 0.001
    Klebsiella pneumoniae6/120 (5.0)5/109 (4.6)5/87 (5.7)0/115 (0.0)6/139 (4.3)9/136 (6.6)4/129 (3.1)8/162 (4.9)11/154 (7.1)9/191 (4.7)18/196 (9.2)0.04
    K. oxytoca0/4 (0.0)3/20 (15.0)3/23 (13.0)1/25 (4.0)1/22 (4.5)0/18 (0.0)1/23 (4.3)0/23 (0.0)1/30 (3.3)0/40 (0.0)0/33 (0.0)0.002
    Proteus mirabilis0/23 (0.0)0/30 (0.0)0/26 (0.0)0/27 (0.0)0/34 (0.0)0/31 (0.0)2/38 (5.3)0/30 (0.0)0/32 (0.0)0/36 (0.0)1/35 (2.8)0.3
    ST131 clonal type among ESBL-producing E. coli6/19 (31.6)8/13 (61.5)20/28 (71.4)16/26 (61.5)19/32 (59.4)27/46 (58.7)36/58 (62.1)54/80 (67.5)40/65 (61.5)48/76 (63.2)65/89 (73.0)0.03
    • Note: ESBL = extended-spectrum β-lactamase.

    • ↵* For the trend observed between 2006 and 2016 (χ2 test for trend).

    • View popup
    Table 2:

    Proportion of Escherichia coli blood culture isolates that produced extended-spectrum β-lactamase in intensive care units and emergency departments, 2006–2016

    SettingYear; no. (%) of isolatesp value*
    20062007200820092010201120122013201420152016
    Intensive care unit1/9 (11.1)1/17 (5.9)1/10 (10.0)2/19 (10.5)2/26 (7.7)2/18 (11.1)5/25 (20.0)6/32 (18.8)7/28 (25.0)7/39 (17.9)8/31 (25.8)0.02
    Emergency department6/180 (3.3)4/172 (2.3)14/206 (6.8)13/201 (6.5)14/128 (10.9)28/264 (10.6)35/272 (12.9)44/287 (15.3)27/298 (9.1)31/300 (10.3)47/318 (14.8)< 0.001
    • ↵* For the trend observed between 2006 and 2016 (χ2 test for trend.)

    • View popup
    Table 3:

    Susceptibility to selected antimicrobial agents of all Escherichia coli isolates, E. coli that did not produce extended-spectrum β-lactamase and E. coli that produced extended-spectrum β-lactamase, 2016

    Agent% of isolates susceptiblep value*
    All Escherichia coli
    n = 513
    Non–ESBL-producing Escherichia coli
    n = 424
    ESBL-producing Escherichia coli
    n = 89
    Ciprofloxacin64.375.710.1< 0.001
    Trimethoprim–sulfamethoxazole66.973.833.7< 0.001
    Tobramycin80.587.348.3< 0.001
    Gentamicin85.488.271.9< 0.001
    Ceftriaxone81.398.30.0< 0.001
    Ertapenem99.8100.098.90.2
    Meropenem/imipenem100.0100.0100.0–
    • Note: ESBL = extended spectrum β-lactamase.

    • ↵* For the difference in susceptibility between non–ESBL-producing E. coli and ESBL-producing E. coli (Fisher exact test).

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CMAJ Open: 6 (4)
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Emerging antimicrobial resistance among Escherichia coli strains in bloodstream infections in Toronto, 2006–2016: a retrospective cohort study
Sophie Mineau, Robert Kozak, Melissa Kissoon, Aimee Paterson, Anthony Oppedisano, Firas Douri, Kate Gogan, Barbara M. Willey, Allison McGeer, Susan M. Poutanen
Oct 2018, 6 (4) E580-E586; DOI: 10.9778/cmajo.20180039

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Emerging antimicrobial resistance among Escherichia coli strains in bloodstream infections in Toronto, 2006–2016: a retrospective cohort study
Sophie Mineau, Robert Kozak, Melissa Kissoon, Aimee Paterson, Anthony Oppedisano, Firas Douri, Kate Gogan, Barbara M. Willey, Allison McGeer, Susan M. Poutanen
Oct 2018, 6 (4) E580-E586; DOI: 10.9778/cmajo.20180039
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