13 ST131 were detected in the ESBL-producing isolates using a PCR for the pabB allele, recently described by Clermont and colleagues.14 MLST was performed on those isolates that tested positive for ST131 using seven conserved housekeeping genes (adk, fumC, gyrB, icd, mdh, purA, and recA). A detailed Protease Inhibitor Library research buy protocol

of the MLST procedure, including allelic type and ST assignment methods, is available at MLST databases at the ERI, University College Cork web site (http://mlst.ucc.ie/mlst/dbs/Ecoli). The ESBL-positive isolates were assigned to one of the four main E coli phylogenetic groups (A, B1, B2, and D) by the use of a multiplex PCR-based method.15 The analysis was performed using Stata 9.2 (StataCorp, College Station, TX, USA). Samples submitted from travelers and non-travelers were treated as independent samples and grouped for analysis. Proportions were compared using Fisher’s exact test and continuous data using the Student’s t-test. For all comparisons a p-value <0.05 was deemed to represent statistical significance. A total of 226 Birinapant cell line samples were included; 207 (92%) of samples were submitted from community-based collection sites

and 19 (8%) were submitted from emergency departments. The mean age (±SD) was 37.5 ± 22.5 years and 126 (57%) were females. Among the 113 foreign travelers, 21 traveled to Asia, 18 traveled within North America (17 Mexico and 1 USA), 18 to Caribbean/Central America, 17 to Africa, 12 to India, 10 to Europe, 8 to South America, 6 to the Middle East, and 3 to Australia/New Zealand. Among the 226 stool samples, 191 (85%) were negative, 31 (14%) were positive for ESBL-producing E coli. A number of factors were compared

among travelers and non-travelers and are 4��8C shown in Table 1. Notably, travelers were 5.2 (95% CI 2.1–31.1) times more likely than non-travelers to have an ESBL-producing E coli cultured from their stool (Table 1). Among the 31 isolates, 27 (87%) were non-susceptible (ie, intermediate or resistant) to SXT, 23 (74%) to AMC, 12 (39%) to TZP, 26 (84%) to CIP, 21 (68%) to TOB, 18 (58%) to GEN, and 2 (6%) to AMK. No resistance was detected to ERT or MER. We used the latest CLSI breakpoints for ERT (0.25 µg/mL) and MER (1 µg/mL). Among the 113 foreign travelers, the location of travel was associated with the likelihood of positivity of stool for ESBL-producing E coli as shown in Table 2. The highest rates of ESBL positivity were associated with travel to Africa or the Indian subcontinent (p = 0.001). All the E coli isolates were positive for blaCTX−M genes: 22 produced CTX-M-15, 8 produced CTX-M-14, and 1 produced CTX-M-8. Some of the CTX-M-producing isolates also produced TEM-1 (ie, those with CTX-M-14 and -15) and OXA-1 (only those with CTX-M-15) β-lactamases. No other types of ESBLs were present.