Microbiol Immunol. 2013 May;57(5):391-5. doi: 10.1111/1348-0421.12046.

Cephalosporin resistant Escherichia coli from cancer patients in Cairo, Egypt.

Abdelaziz MO, Bonura C, Aleo A, Fasciana T, Calà C, Mammina C.

Department of Microbiology and Immunology, Faculty of Pharmacy, Helwan University, Main Campus, Helwan, Cairo 11795, Egypt.



Cephalosporin-resistant Escherichia coli has been increasingly reported worldwide. In this study, 32 cephalosporin resistant E. coli isolates identified from cancer patients in Cairo, Egypt in 2009-2010 were analyzed. Twenty-three were of phylogenetic group D, seven A and one each B1 and B2. By rep-PCR 15 phylogroup D isolates were grouped in four clusters, one with sequence type (ST) 405 and three ST68. Seventeen isolates showed single patterns. blaCTX-M-15 and aac(6′)-Ib-cr were the most common resistance determinants. blaOXA-48 and blaVIM were also detected. Multidrug resistant E. coli seriously affects healthcare, especially in immunocompromised hosts, such as cancer patients.

© 2013 The Societies and Wiley Publishing Asia Pty Ltd.

PMID: 23668612



The emergence of multidrug resistance in Escherichia coli has become a global concern, with particular emphasis on E. coli sequence type (ST) 131, which is being increasingly reported in human infection cases. ST131,  as well as high levels of ESBL carriage, are especially prevalent in the more serious infection cases, such as bacteremia. This is suggestive of a selective pressure by ESBL mediated drug resistance and, consequently, by prolonged antimicrobial drug treatments, in the emergence of some successful STs from the wider population of Extraintestinal Pathogenic E. coli (ExPEC).

Multidrug-resistant Escherichia coli is a very concerning threat to critically ill and immunocompromised individuals, such as cancer patients. MDR E coli infections are, indeed, associated with high morbidity and mortality, as well with high costs for patients and healthcare facilities. Cancer patients undergoing chemotherapy have several risk factors for MDR Gram negative infections, such as neutropenia, prolonged hospital stays and frequent exposure to invasive devices. Moreover, they can receive antibiotic prophylaxis, which results in an imbalance of the intestinal microbiota which may in turn result in the selection of resistant organisms such as MDR E coli. Horizontal acquisition via cross transmission is also possible.  Implementation of strict infection control measures as well as antibiotic stewardship have a major role in prevent or limit spread of these organisms.

It is not clear what features of the pathogen, host population, environment and their interaction have allowed MDR E. coli to disseminate so widely and rapidly. Both person-to- person and foodborne transmission have been documented. Potential reservoirs of ST131, including food or water sources, and travel from countries with a high endemicity of MDR Gram negatives, have been proposed as possible explanations for the rapid emergence and spread of these clones. One of the most concerning issue is the huge reservoir of MDR strains and resistance genetic determinants  in the commensal flora of food animals. Indeed, over the past decades, the abuse/misuse of antimicrobials in animals has generated an enormous antimicrobial pressure on commensal bacteria.  E. coli, being a ubiquitous species encompassing different pathotypes, but also a major member of the normal intestinal flora, appears to play a special role in the accumulation and interplay between resistance traits.

Further studies are indispensable to assess and characterize microbial risks for human subjects, especially those immunocompromised, derived from MDR commensal E. coli strains from food animals. Monitoring of antimicrobial resistance properties of commensal intestinal E. coli from food animals can be an important strategy to assess ongoing trends, and thereby keeping the scientific community and the stakeholders updated about developments on antimicrobial resistance.

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