Characterization of Diarrheagenic Enteroaggregative Escherichia coli in Danish Adults-Antibiotic Treatment Does Not Reduce Duration of Diarrhea

Betina Hebbelstrup Jensen, Camilla Adler Sørensen, Stig Hebbelstrup Rye Rasmussen, Dorthe Rejkjær Holm, Alice Friis-Møller, Jørgen Engberg, Hengameh C. Mirsepasi-Lauridsen, Carsten Struve, Anette M. Hammerum, Lone Jannok Porsbo, Randi Føns Petersen, Andreas Munk Petersen, Karen Angeliki Krogfelt*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

Enteroaggregative Escherichia coli (EAEC) is frequently isolated from sporadic cases of diarrhea and in outbreaks of gastroenteritis in several regions of the world. The pathophysiology of EAEC continues to be enigmatic, and the efficacy of antibiotic treatment in EAEC-associated diarrhea has been discussed. Since the level of antibiotic resistance is increasing, it is essential to restrict the use of antibiotics to prevent further resistance development. We aimed to investigate EAEC strains in adult Danish patients suffering from diarrhea and from healthy controls. We examined the antibiotic resistance in EAEC strains, the clinical response to antibiotic treatment in EAEC diarrheal cases, and the distribution of virulence genes in diarrheal cases. The EAEC strains were collected from patients suffering from diarrhea in a Danish multicenter study. A medical doctor interviewed the patients by using a questionnaire regarding gastrointestinal symptoms, exposures, and use of antibiotic and over-the-counter antidiarrheal drugs. Follow-up was performed after 3-5 months to inquire about differential diagnosis to gastrointestinal disease. A multiplex polymerase chain reaction characterized virulence genes in diarrheal cases. Finally, the level of antibiotic resistance was examined by using the disc diffusion method. Asymptomatic carriage of EAEC in the adult Danish population was rare, in contrast to findings in healthy Danish children. The duration of diarrhea was not shortened by antibiotic treatment, specifically ciprofloxacin treatment, or by over-the-counter antidiarrheal drugs. Follow-up revealed no pathology in diarrheal patients apart from irritable bowel syndrome in two patients. A high number of patients suffered from long-term diarrhea, which was associated with the enterotoxin EAST-1 and a high virulence factor score. A high level of antibiotic resistance was observed and 58% of the EAEC strains were multidrug resistant. Multidrug resistance was most pronounced in cases of travelers' diarrhea, and it was seen that antibiotic treatment did not reduce the duration of diarrhea.

Original languageEnglish
Article number306
JournalFrontiers in Cellular and Infection Microbiology
Volume8
Number of pages12
ISSN2235-2988
DOIs
Publication statusPublished - 1 Jan 2018

Keywords

  • antibiotic resistance
  • diarrhea
  • EAEC
  • Enteroaggregative Escherichia coli
  • multidrug resistance

Cite this

Hebbelstrup Jensen, B., Adler Sørensen, C., Hebbelstrup Rye Rasmussen, S., Rejkjær Holm, D., Friis-Møller, A., Engberg, J., ... Krogfelt, K. A. (2018). Characterization of Diarrheagenic Enteroaggregative Escherichia coli in Danish Adults-Antibiotic Treatment Does Not Reduce Duration of Diarrhea. Frontiers in Cellular and Infection Microbiology, 8, [306]. https://doi.org/10.3389/fcimb.2018.00306
Hebbelstrup Jensen, Betina ; Adler Sørensen, Camilla ; Hebbelstrup Rye Rasmussen, Stig ; Rejkjær Holm, Dorthe ; Friis-Møller, Alice ; Engberg, Jørgen ; Mirsepasi-Lauridsen, Hengameh C. ; Struve, Carsten ; Hammerum, Anette M. ; Porsbo, Lone Jannok ; Petersen, Randi Føns ; Petersen, Andreas Munk ; Krogfelt, Karen Angeliki. / Characterization of Diarrheagenic Enteroaggregative Escherichia coli in Danish Adults-Antibiotic Treatment Does Not Reduce Duration of Diarrhea. In: Frontiers in Cellular and Infection Microbiology. 2018 ; Vol. 8.
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title = "Characterization of Diarrheagenic Enteroaggregative Escherichia coli in Danish Adults-Antibiotic Treatment Does Not Reduce Duration of Diarrhea",
abstract = "Enteroaggregative Escherichia coli (EAEC) is frequently isolated from sporadic cases of diarrhea and in outbreaks of gastroenteritis in several regions of the world. The pathophysiology of EAEC continues to be enigmatic, and the efficacy of antibiotic treatment in EAEC-associated diarrhea has been discussed. Since the level of antibiotic resistance is increasing, it is essential to restrict the use of antibiotics to prevent further resistance development. We aimed to investigate EAEC strains in adult Danish patients suffering from diarrhea and from healthy controls. We examined the antibiotic resistance in EAEC strains, the clinical response to antibiotic treatment in EAEC diarrheal cases, and the distribution of virulence genes in diarrheal cases. The EAEC strains were collected from patients suffering from diarrhea in a Danish multicenter study. A medical doctor interviewed the patients by using a questionnaire regarding gastrointestinal symptoms, exposures, and use of antibiotic and over-the-counter antidiarrheal drugs. Follow-up was performed after 3-5 months to inquire about differential diagnosis to gastrointestinal disease. A multiplex polymerase chain reaction characterized virulence genes in diarrheal cases. Finally, the level of antibiotic resistance was examined by using the disc diffusion method. Asymptomatic carriage of EAEC in the adult Danish population was rare, in contrast to findings in healthy Danish children. The duration of diarrhea was not shortened by antibiotic treatment, specifically ciprofloxacin treatment, or by over-the-counter antidiarrheal drugs. Follow-up revealed no pathology in diarrheal patients apart from irritable bowel syndrome in two patients. A high number of patients suffered from long-term diarrhea, which was associated with the enterotoxin EAST-1 and a high virulence factor score. A high level of antibiotic resistance was observed and 58{\%} of the EAEC strains were multidrug resistant. Multidrug resistance was most pronounced in cases of travelers' diarrhea, and it was seen that antibiotic treatment did not reduce the duration of diarrhea.",
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Hebbelstrup Jensen, B, Adler Sørensen, C, Hebbelstrup Rye Rasmussen, S, Rejkjær Holm, D, Friis-Møller, A, Engberg, J, Mirsepasi-Lauridsen, HC, Struve, C, Hammerum, AM, Porsbo, LJ, Petersen, RF, Petersen, AM & Krogfelt, KA 2018, 'Characterization of Diarrheagenic Enteroaggregative Escherichia coli in Danish Adults-Antibiotic Treatment Does Not Reduce Duration of Diarrhea', Frontiers in Cellular and Infection Microbiology, vol. 8, 306. https://doi.org/10.3389/fcimb.2018.00306

Characterization of Diarrheagenic Enteroaggregative Escherichia coli in Danish Adults-Antibiotic Treatment Does Not Reduce Duration of Diarrhea. / Hebbelstrup Jensen, Betina; Adler Sørensen, Camilla; Hebbelstrup Rye Rasmussen, Stig; Rejkjær Holm, Dorthe; Friis-Møller, Alice; Engberg, Jørgen; Mirsepasi-Lauridsen, Hengameh C.; Struve, Carsten; Hammerum, Anette M.; Porsbo, Lone Jannok; Petersen, Randi Føns; Petersen, Andreas Munk; Krogfelt, Karen Angeliki.

In: Frontiers in Cellular and Infection Microbiology, Vol. 8, 306, 01.01.2018.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Characterization of Diarrheagenic Enteroaggregative Escherichia coli in Danish Adults-Antibiotic Treatment Does Not Reduce Duration of Diarrhea

AU - Hebbelstrup Jensen, Betina

AU - Adler Sørensen, Camilla

AU - Hebbelstrup Rye Rasmussen, Stig

AU - Rejkjær Holm, Dorthe

AU - Friis-Møller, Alice

AU - Engberg, Jørgen

AU - Mirsepasi-Lauridsen, Hengameh C.

AU - Struve, Carsten

AU - Hammerum, Anette M.

AU - Porsbo, Lone Jannok

AU - Petersen, Randi Føns

AU - Petersen, Andreas Munk

AU - Krogfelt, Karen Angeliki

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Enteroaggregative Escherichia coli (EAEC) is frequently isolated from sporadic cases of diarrhea and in outbreaks of gastroenteritis in several regions of the world. The pathophysiology of EAEC continues to be enigmatic, and the efficacy of antibiotic treatment in EAEC-associated diarrhea has been discussed. Since the level of antibiotic resistance is increasing, it is essential to restrict the use of antibiotics to prevent further resistance development. We aimed to investigate EAEC strains in adult Danish patients suffering from diarrhea and from healthy controls. We examined the antibiotic resistance in EAEC strains, the clinical response to antibiotic treatment in EAEC diarrheal cases, and the distribution of virulence genes in diarrheal cases. The EAEC strains were collected from patients suffering from diarrhea in a Danish multicenter study. A medical doctor interviewed the patients by using a questionnaire regarding gastrointestinal symptoms, exposures, and use of antibiotic and over-the-counter antidiarrheal drugs. Follow-up was performed after 3-5 months to inquire about differential diagnosis to gastrointestinal disease. A multiplex polymerase chain reaction characterized virulence genes in diarrheal cases. Finally, the level of antibiotic resistance was examined by using the disc diffusion method. Asymptomatic carriage of EAEC in the adult Danish population was rare, in contrast to findings in healthy Danish children. The duration of diarrhea was not shortened by antibiotic treatment, specifically ciprofloxacin treatment, or by over-the-counter antidiarrheal drugs. Follow-up revealed no pathology in diarrheal patients apart from irritable bowel syndrome in two patients. A high number of patients suffered from long-term diarrhea, which was associated with the enterotoxin EAST-1 and a high virulence factor score. A high level of antibiotic resistance was observed and 58% of the EAEC strains were multidrug resistant. Multidrug resistance was most pronounced in cases of travelers' diarrhea, and it was seen that antibiotic treatment did not reduce the duration of diarrhea.

AB - Enteroaggregative Escherichia coli (EAEC) is frequently isolated from sporadic cases of diarrhea and in outbreaks of gastroenteritis in several regions of the world. The pathophysiology of EAEC continues to be enigmatic, and the efficacy of antibiotic treatment in EAEC-associated diarrhea has been discussed. Since the level of antibiotic resistance is increasing, it is essential to restrict the use of antibiotics to prevent further resistance development. We aimed to investigate EAEC strains in adult Danish patients suffering from diarrhea and from healthy controls. We examined the antibiotic resistance in EAEC strains, the clinical response to antibiotic treatment in EAEC diarrheal cases, and the distribution of virulence genes in diarrheal cases. The EAEC strains were collected from patients suffering from diarrhea in a Danish multicenter study. A medical doctor interviewed the patients by using a questionnaire regarding gastrointestinal symptoms, exposures, and use of antibiotic and over-the-counter antidiarrheal drugs. Follow-up was performed after 3-5 months to inquire about differential diagnosis to gastrointestinal disease. A multiplex polymerase chain reaction characterized virulence genes in diarrheal cases. Finally, the level of antibiotic resistance was examined by using the disc diffusion method. Asymptomatic carriage of EAEC in the adult Danish population was rare, in contrast to findings in healthy Danish children. The duration of diarrhea was not shortened by antibiotic treatment, specifically ciprofloxacin treatment, or by over-the-counter antidiarrheal drugs. Follow-up revealed no pathology in diarrheal patients apart from irritable bowel syndrome in two patients. A high number of patients suffered from long-term diarrhea, which was associated with the enterotoxin EAST-1 and a high virulence factor score. A high level of antibiotic resistance was observed and 58% of the EAEC strains were multidrug resistant. Multidrug resistance was most pronounced in cases of travelers' diarrhea, and it was seen that antibiotic treatment did not reduce the duration of diarrhea.

KW - antibiotic resistance

KW - diarrhea

KW - EAEC

KW - Enteroaggregative Escherichia coli

KW - multidrug resistance

U2 - 10.3389/fcimb.2018.00306

DO - 10.3389/fcimb.2018.00306

M3 - Journal article

VL - 8

JO - Frontiers in Cellular and Infection Microbiology

JF - Frontiers in Cellular and Infection Microbiology

SN - 2235-2988

M1 - 306

ER -