Spatiotemporal Trends and Co-Resistance Patterns of Multidrug-Resistant Enteric Escherichia coli O157 Infections in Humans in the United States.

Multidrug-resistant (MDR) Shiga toxin-producing Escherichia coli O157 (STEC O157) is a public health threat. This study analyzed publicly available surveillance data collected by the National Antimicrobial Resistance Monitoring System (NARMS) to assess temporal and regional differences and co-resistance patterns in MDR STEC O157 human clinical isolates across the United States. Co-resistance patterns were assessed by hierarchical clustering and Phi coefficient network analyses. A negative binomial regression model estimated the incidence rate ratios (IRRs) for the number of antimicrobial classes to which an isolate was resistant, across years and geographic regions. Out of 1955 isolates, 151 (7.57%) were MDR. The most important clusters were Cluster 1 (n = 1632), which included susceptible isolates, and Cluster 3 (n = 255), comprising the majority of the MDR isolates, having a high resistance prevalence to tetracyclines (TET) (0.97), folate pathway inhibitors (FPI) (0.77), and phenicols (PHN) (0.49). In the co-resistance network, TET, FPI, and PHN served as central hubs, with large nodes and thick edges, suggesting that they are frequently co-selected. The highest IRRs were observed in Regions 6 (IRR = 2.72) and 9 (IRR = 2.00), compared to Region 4. Compared to 2010, a significant increase in the IRR was observed in each year from 2015 to 2021 (IRRs 2.5-4.38). Antimicrobial stewardship programs and public health interventions targeting MDR E. coli O157 are needed to mitigate the emergence of antimicrobial resistance.