coli O25b-ST131

is estimated at 7% in healthy adults [47]; however the rate of E. coli O25b-ST131 susceptible to extended-spectrum HER2 inhibitor cephalosporins has never been reported. We identified 3.6% of the E. coli O131 isolates did not contain any of the related resistance genes which reflect the infection caused by cephalosporin-susceptible clones. Conclusion We did not find any association between resistance profiles and genotypes. However; we detected for the first time the appearance bla CTX-M-2 in the Middle East and bla CTX-M-56 outside Latin America. We also identified the spread of qnrB1 and qnrS1 in isolates harbouring aac(6’)-Ib Ib-cr and bla CTX-M. The isolate harbouring bla CTX-M-56 also contained qnrB1 and bla

CMY-2 genes and carried IncF1 plasmids. In conclusion the appearance of a highly virulent E. coli O25b-ST131 that is resistant to penicillins, most cephalosproins, βbuy AR-13324 -lactamase inhibitors as well as floroquinolones is a cause for concern and poses a risk to combination β-lactam/ β-lactamase inhibitor therapy. Acknowledgement The authors would like to thank Miss Shorooq Barrak Al-Inizi eFT-508 nmr for her technical support. The authors would also like to acknowledge the Research Unit for Genomics, Proteomics and Cellomics Studies (OMICS) of the Health Sciences Centre, Kuwait University (Project No. SRUL02/13) for assisting in DNA sequencing. Funding This work was supported by Kuwait University Research Administration Grant number NM02/10 and the Kuwait Foundation

for Advancement of Science (KFAS), Grant no. 2011130204. Additional file Additional file 1: Table S1. Specimen types and Demographics of E. coli O25b-B2-ST131 isolates. Samples from pus, skin and wound have been illustrated under soft tissue. References Adenylyl cyclase 1. Peirano G, Pitout JDD: Molecular epidemiology of Escherichia coli producing CTX-M beta-lactamases: the worldwide emergence of clone ST131 O25:H4. Int J Antimicrob Agents 2010, 35:316–321.PubMedCrossRef 2. Dahbi G, Mora A, López C, Alonso MP, Mamani R, Marzoa J, Coira A, García-Garrote F, Pita JM, Velasco D, Herrera A, Viso S, Blanco JE, Blanco M, Blanco J: Emergence of new variants of ST131 clonal group among extraintestinal pathogenic Escherichia coli producing extended-spectrum β-lactamases. Int J Antimicrob Agents 2013, 42:347–351. doi: 10.1016/j.ijantimicag.PubMedCrossRef 3. Karisik E, Ellington MJ, Pike R, Warren RE, Livermore DM, Woodford N: Molecular characterization of plasmids encoding CTX-M-15 β-lactamases from Escherichia coli strains in the United States. J Antimicrob Chemother 2006, 58:665–668.PubMedCrossRef 4. Lau SH, Kaufmann MK, Livermore DM, Woodford N, Willshaw GA, Cheasty T, Stamper K, Reddy S, Cheesbrough J, Bolton FJ, Fox AJ, Upton M: UK epidemic Escherichia coli strains A E, with CTX-M-15 β-lactamase, all belong to the international O25:H4-ST131 clone. J Antimicrob Chemother 2008, 62:1241–1244.PubMedCrossRef 5.