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JAC Advance Access originally published online on May 27, 2009
Journal of Antimicrobial Chemotherapy 2009 64(2):343-347; doi:10.1093/jac/dkp178
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Evolution of antimicrobial resistance in enteroaggregative Escherichia coli and enterotoxigenic Escherichia coli causing traveller's diarrhoea

Eva Mendez Arancibia1, Cristina Pitart1, Joaquim Ruiz2, Francesc Marco1, Joaquim Gascón2 and Jordi Vila1,*

1 Department of Clinical Microbiology, Hospital Clinic, University of Barcelona, School of Medicine, Villarroel, 170, 08036 Barcelona, Spain 2 Tropical Medicine Unit, Centre de Salut Internacional, Hospital Clinic, Villarroel, 170, 08036 Barcelona, Spain

Received 31 January 2009; returned 12 March 2009; revised 24 April 2009; accepted 24 April 2009

* Corresponding author. Servei de Microbiologia, Centre de Diagnòstic Biomèdic, Hospital Clínic, Villarroel, 170, 08036 Barcelona, Spain. Tel: +34-93-2275522; Fax: +34-93-2279372; E-mail: jvila{at}ub.edu

Objectives: Enteroaggregative Escherichia coli (EAEC) and enterotoxigenic E. coli (ETEC) are among the most frequent microorganisms causing traveller's diarrhoea. The aim of this study was to investigate the evolution of antimicrobial resistance in EAEC and ETEC causing diarrhoea in patients who had travelled to different developing countries, comparing two periods of time, 1994–97 and 2001–04.

Methods: Overall, 134 EAEC and 190 ETEC clinical isolates were studied. The MICs of ampicillin, chloramphenicol, nalidixic acid, tetracycline, trimethoprim/sulfamethoxazole, ciprofloxacin and amoxicillin/clavulanic acid were determined by the Etest method. Detection of mutations in the quinolone-resistance determining region of the gyrA and parC genes was performed by PCR and DNA sequencing.

Results: When antimicrobial resistance in EAEC and ETEC isolates was compared between the two periods of time, a statistically significant increase in resistance (P < 0.01) was observed in EAEC for chloramphenicol and amoxicillin/clavulanic acid, whereas in ETEC it was for trimethoprim/sulfamethoxazole, nalidixic acid, ciprofloxacin and amoxicillin/clavulanic acid. Mutations in the gyrA gene were found in all nalidixic acid-resistant isolates, whereas mutation(s) in both gyrA and parC genes were found in the ciprofloxacin-resistant isolates.

Conclusions: The high percentage of resistance to quinolones in ETEC and EAEC isolated from travellers to North Africa and India is a matter for concern. These agents should therefore be used with caution in patients with traveller's diarrhoea returning from these geographical areas.

Keywords: ETEC , EAEC , India , quinolones , resistance


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