Multidrug-resistant Escherichia coli clonal groups causing community-acquired pyelonephritis.

From October 1999 through January 2000, an Escherichia coli clonal group (designated "CgA") was isolated from the urine of nearly one-half of all women with urinary tract infections (UTIs) caused by trimethoprim-sulfamethoxazole (TMP-SMZ)-resistant E. coli in a California community. This study describes the prevalence of pyelonephritis caused by CgA in the same community. E. coli isolates were characterized by enterobacterial repetitive intergenic consensus (ERIC2) polymerase chain reaction (PCR), serogrouping, and pulsed-field gel electrophoresis. Fourteen (11%) of 130 women with UTIs received a diagnosis of pyelonephritis. CgA was associated with 4 (57%) of the 7 pyelonephritis cases caused by TMP-SMZ-resistant E. coli and was associated with none of the cases caused by TMP-SMZ-susceptible E. coli (P<.02). Six (86%) of these TMP-SMZ-resistant E. coli isolates belonged to 2 distinct ERIC2 PCR-defined clonal groups, whereas all of the TMP-SMZ-susceptible E. coli strains had unique fingerprints (P<.001). The prevalence of antimicrobial-resistant pyelonephritis in a community may be affected by a limited number of E. coli clonal groups.

Retail meat consumption and the acquisition of antimicrobial resistant Escherichia coli causing urinary tract infections: a case-control study.

BACKGROUND: The increasing incidence of community-acquired urinary tract infections (UTIs) caused by antimicrobial resistant Escherichia coli, and observations of potential outbreaks of UTI-causing E. coli, suggest that food may be an important source of E. coli in women who develop UTI. We sought to determine if acquisition of and infection with a UTI-causing, antimicrobial resistant E. coli isolate is associated with a woman's dietary habits, specifically her preparation and consumption of retail meat products. METHODS: Between April 2003 and June 2004, a case-control study was conducted. The dietary habits of women with UTI caused by an antimicrobial resistant E. coli (cases) and women with UTI caused by fully susceptible E. coli (controls) were compared. Broth microdilution was used to perform antimicrobial resistance testing. All E. coli isolates were genotyped by the pulsed-field gel electrophoresis (PFGE) method. RESULTS: Ninety-nine women met study criteria. Women who were infected with multidrug-resistant E. coli reported more frequent chicken consumption (adjusted OR = 3.7, 95% CI 1.1, 12.4). Women with UTI caused by an ampicillin- or cephalosporin-resistant E. coli isolate reported more frequent consumption of pork (adjusted OR = 3.2, 95% CI 1.0, 10.3 and adjusted OR = 4.0, 95% CI 1.0, 15.5, respectively). Frequent alcohol consumption was associated with antimicrobial resistant UTI. CONCLUSIONS: This study provides epidemiologic evidence that antimicrobial resistant, UTI-causing E. coli could have a food reservoir, possibly in poultry or pork.