Journal List > J Bacteriol Virol > v.43(1) > 1034106

Jin, Seung, Oh, Jung, Jeon, Lee, Kim, Choi, and Chae: Epidemiological Relationship of Enterotoxigenic Escherichia coli and Enteroaggregative E. coli Isolated from Patients with Diarrhea in Seoul

Abstract

Of total 1,438 specimens of patients with diarrhea in Seoul, 2011, 217 samples (15%) were found pathogenic Escherichia coli that included 192 strains (89%) of enterotoxigenic E. coli (ETEC) and enteroaggregative E. coli (EAEC). The highest isolation rate for ETEC and EAEC was found in August and September. Sixty two pathogenic E. coli strains (34 ETEC and 28 EAEC strains) were selected from 175 strains (94 ETEC and 81 EAEC strains) isolated in August and September. Of 94 strains characterized for ETEC phenotype, 76 (81%) expressed heat-stable toxin (ST) only. Antimicrobial susceptibility test was carried out by using sixteen types of antibiotics. A high level of antimicrobial resistance to tetracycline (57%), ampicillin and ticarcillin (54%) was observed among EAEC isolates while the highest resistance rate of ETEC was found for nalidixic acid (47%), followed by tetracycline (32%). As to the antimicrobial susceptibility test, EAEC showed the complicated multi-drug resistant patterns in which the resistance was higher than ETEC. Pulsed-field gel electrophoresis (PFGE) was carried out to examine the genetic relatedness among ETEC and EAEC isolates. Except for 11 strains, 51 strains were divided by eight pulsotypes. In PFGE analysis, isolates from foodborne disease outbreaks in August and September 2011 showed close relation.

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Figure 1.
Dendrogram showing the clustering of PFGE patterns for the 62 ETEC and EAEC isolates. A group indicates 81.5% similarity; B group indicates 82% similarity; C group indicates 80.3% similarity; D group indicates 84.7% similarity; E groups indicate 81.1% similarity; F groups indicate 82.4% similarity; G group indicates 84.3% similarity; H group indicates 87.2% similarity.
jbv-43-37f1.tif
Table 1.
Isolation and region distribution of 62 ETEC and EAEC in diarrhea patients in Seoul
Case Group Region (Gu) Occurrence place Receipt date Pathogenic gene Selection numbera
Outbreak O1 Dobong Police office 2011-8-17 ST
ST
4/21
4/12
O2 Dobong School 2011-8-29 LT
aggR
6/9
12/42
O3 Seocho School 2011-8-29 ST
LT
aggR
3/10
4/6
8/31
O4 Yangcheon Company 2011-9-6 ST 6/29
O5 Songpa School 2011-9-27 aggR 4/4
Sporadic S1 Gwangjin Southeast Asia travel 2011-8-8 ST 1
S2 Gwanak Southeast Asia travel (Cambodia) 2011-8-9 aggR 1
S3 Southeast Asia travel 2011-8-12 ST 1
S4 Yangcheon Southeast Asia travel 2011-8-12 aggR 1
S5 Nowon Southeast Asia travel (China) 2011-8-23 ST 1
S6 Other 2011-8-24 ST 1
S7 Dongjak Other 2011-8-24 aggR 1
S8 Gangdong Restaurant 2011-8-24 ST 1
S9 Seongbuk Southeast Asia travel (Philippine) 2011-9-6 aggR 1
S10 Nowon Southeast Asia travel 2011-9-8 ST, LT 1
S11 Jungnang Southeast Asia travel 2011-9-22 ST, LT 1
Total 62

a indicates the number of selected strains from the total isolates number.

Table 2.
Resistance of the isolated 62 ETEC and EAEC strains to antimicrobial drugs
No.(%) of isolates resistant toa
AM AN SAM CF CZ FEP CTT CTX CIP C GM IPM NA TE TIC SXT
EAEC (n=28) 15 (54) 0 0 2 (7) 2 (7) 0 0 1 (4) 0 4 (14) 2 (7) 1 (4) 13 (46) 16 (57) 15 (54) 12 (43)
ETEC (n=34) 6 (18) 0 0 0 0 0 0 0 0 1 (3) 0 0 16 (47) 11 (32) 6 (18) 5 (15)
Total (n=62) 21 (34) 0 0 2 (3.2) 2 (3.2) 0 0 1 (1.6) 0 5 (8.1) 2 (3.2) 1 (1.6) 29 (47) 27 (44) 21 (34) 17 (27)

a Abbreviations: AM, ampicillin; AN, amikacin; SAM, ampicillin/sulbatam; CF, cephalothin; CZ, cefazolin; FEP, cefepime; CTT, cefotetan; CTX, cefotaxime; CIP, ciprofloxacin; C, chloramphenicol; GM, gentamicin; IPM, imipenem; NA, nalidixic acid; Te, tetracycline; TIC, ticarcillin; SXT, trimethoprim/sulfamethoxazole

Table 3.
Distribution of the antimicrobial resistance patterns of 62 ETEC and EAEC isolates
Case Group Region (Gu) Pathogenic gene Selection number Antimicrobial resistant patterns (numbers)a
Outbreak O1 Dobong ST
ST
4
4
TE (4)
NA, NA-TE, AM-NA-TE-TIC-SXT
O2 Dobong LT
aggR
ST
6
12
3

TE, NA-TE, AM-NA-TIC, AM-NA-TIC-SXT, AM-TE-TIC-SXT (2), AM-C-NA-TIC-SXT, AM-NA-TE-TIC-SXT, AM-CF-CZ-C-GM-NA-TIC
NA (3)
O3 Seocho LT
aggR
4
8

TE (2), AM-TIC, NA-TE, NA-TE-SXT, AM-IPM-NA-TE-TIC, AM-GM-TE-TIC-SXT
O4 Yangcheon ST 6 NA (5), NA-TE
O5 Songpa aggR 4 NA-TE-SXT (2), AM-TE-TIC-SXT (2)
Sporadic S1 Gwangjinb ST 1 AM-NA-TE-TIC-SXT
S2 Gwanakb aggR 1 AM-CF-CZ-CTX-TE-SXT
S3 Yangcheonb ST 1 AM-NA-TE-TIC-SXT
S4 aggR 1 AM-C-NA-TIC
S5 Nowonb ST 1 NA
S6 Dongjak ST 1 AM-TE-TIC-SXT
S7 aggR 1 AM-C-NA-TIC-SXT
S8 Gangdong ST 1 NA
S9 Seongbukb aggR 1
S10 Nowonb ST, LT 1 AM-TE-TIC
S11 Jungnangb ST, LT 1 AM-TIC-SXT

a Abbreviations: AM, ampicillin; AN, amikacin; SAM, ampicillin/sulbatam; CF, cephalothin; CZ, cefazolin, FEP, cefepime; CTT, cefotetan; CTX, cefotaxime; CIP, ciprofloxacin; C, chloramphenicol; GM, gentamicin; IPM, imipenem; NA, nalidixic acid; Te, tetracycline; TIC, ticarcillin; SXT, trimethoprim/sulfamethoxazole

b indicates Southeast Asia traveler.

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