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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.
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 |
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
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