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JAC Advance Access published online on February 7, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl020
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© The Author 2006. 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
Received October 18, 2005
Revised January 9, 2006
Accepted January 13, 2006

Original article

The role of horizontal gene transfer in the spread of trimethoprim-sulfamethoxazole resistance among uropathogenic Escherichia coli in Europe and Canada

Matthew T. Blahna 1, Christy Ann Zalewski 1, Jennifer Reuer 1, Gunnar Kahlmeter 2, Betsy Foxman 1, and Carl F. Marrs 1 *

1 Department of Epidemiology, University of Michigan, School of Public Health, 109 S Observatory, Ann Arbor, MI 48109, USA
2 Department of Clinical Microbiology, Central Hospital, SE-351 85 Växjö, Sweden

* To whom correspondence should be addressed.
Carl F. Marrs, E-mail: cfmarrs{at}umich.edu


  Abstract

Objectives: To describe the distribution of trimethoprim-sulfamethoxazole resistance genes and the role of horizontal gene transfer and clonal expansion in recent increases of antibiotic resistance rates among uropathogenic Escherichia coli in Europe and Canada.

Methods: We identified antibiotic resistance alleles sul1, sul2, sul3 and dfr along with type 1 and type 2 integrons among 350 uropathogenic E. coli isolates from a cross-sectional study of acute, uncomplicated, community-acquired urinary tract infections in 16 western European countries and Canada (ECO•SENS).

Results: Trimethoprim resistance gene distributions showed no regional dependency (P = 0.84). The most common trimethoprim resistance gene was dfrA1, which occurred in 37.9% of dfr containing isolates. Similarly, the sulfamethoxazole resistance gene distributions did not vary significantly by region (P = 0.20). sul2, the most common sulfamethoxazole resistance gene, was found in 77.9% of sulfamethoxazole-resistant isolates. The distribution of type 1 and type 2 integrons varied slightly by region (P = 0.04) with type 1 integrons being the more common (85.9%). We observed 34 combinations of the sul genes, dfr genes and integron types; the most common combinations were broadly disseminated across every region examined.

Conclusions: Horizontal gene transfer plays a larger role than clonal expansion in the increase of trimethoprim-sulfamethoxazole resistance levels in Europe and Canada.

Keywords: urinary tract infections; epidemiology; antimicrobial resistance; integrons; E. coli.
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