MgrB Inactivation Is Responsible for Acquired Resistance to Colistin in Enterobacter hormaechei subsp. steigerwaltii

Multidrug-resistant strains belonging to the Enterobacter cloacae complex (ECC) group, and especially those belonging to clusters C-III, C-IV, and C-VIII, have increasingly emerged as a leading cause of health care-associated infections, with colistin used as one of the last lines of treatment. However, colistin-resistant ECC strains have emerged. The aim of this study was to prove that MgrB, the negative regulator of the PhoP/PhoQ two-component regulatory system, is involved in colistin resistance in ECC of cluster C-VIII, formerly referred to as Enterobacter hor-maechei subsp. steigerwaltii. An in vitro mutant (Eh22-Mut) was selected from a clinical isolate of Eh22. The sequencing analysis of its mgrB gene showed the presence of one nucleotide deletion leading to the formation of a truncated protein of six instead of 47 amino acids. The wild-type mgrB gene from Eh22 and that of a clinical strain of Klebsiella pneumoniae used as controls were cloned, and the corresponding recombinant plasmids were used for complementation assays. The results showed a fully restored susceptibility to colistin and confirmed for the first time that mgrB gene expression plays a key role in acquired resistance to colistin in ECC strains

Incomplete hippocampalInversion : a comprehensive MRI study of over 2000 subjects

The incomplete-hippocampal-inversion (IHI), also known as malrotation, is an atypical anatomical pattern of the hippocampus, which has been reported in healthy subjects in different studies. However, extensive characterization of IHI in a large sample has not yet been performed. Furthermore, it is unclear whether IHI are restricted to the medial-temporal lobe or are associated with more extensive anatomical changes. Here, we studied the characteristics of IHI in a community-based sample of 2008 subjects of the IMAGEN database and their association with extra-hippocampal anatomical variations. The presence of IHI was assessed on T1-weighted anatomical magnetic resonance imaging (MRI) using visual criteria. We assessed the association of IHI with other anatomical changes throughout the brain using automatic morphometry of cortical sulci. We found that IHI were much more frequent in the left hippocampus (left: 17%, right: 6%, χ2−test, p < 10−28). Compared to subjects without IHI, subjects with IHI displayed morphological changes in several sulci located mainly in the limbic lobe. Our results demonstrate that IHI are a common left-sided phenomenon in normal subjects and that they are associated with morphological changes outside the medial temporal lobe

First description of NDM-1-positive Klebsiella pneumoniae in the Tunisian community

First description of NDM-1-positive Klebsiella pneumoniae in the Tunisian community Sir, Multidrug-resistant bacteria, especially carbapenemase-producing Enterobacteriaceae, are a major public health-threat worldwide. As part of a collaborative monitoring programme, our laboratory at the University of Bordeaux has received a collection of multidrug-resistant bacterial strains to further characterise their β-lactamase content. They were sent from private Tunisian diagnostic laboratories and were collected from community patients suffering from urinary tract infection. In this context, multidrug-resistant isolate 18TA was collected in January 2018 in Sfax region from the urine of a 45-year old female with no previous hospitalisation during the preceding month and no history of recent foreign travel. Strain 18TA had been initially classified as Enterobacter spp. by biochemical tests (API 10S gallery). Following matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS) (Bruker Daltonics) and confirmation by PCR amplification and sequencing of 16S rDNA, strain 18TA was re-identified as Klebsiella pneumoniae. Multilocus sequence typing (MLST) (http:// bigsdb.pasteur.fr/klebsiella/klebsiella.html) indicated that strain 18TA belonged to Sequence Type (ST), ST147. Minimum inhibitory concentrations (MICs) of various anti-microbials were determined using a BD Phoenix TM 100 automated system (BD Diagnostic Systems, Le Pont-de-Claix, France) and the results were interpreted using BD EpiCenter TM software (BD Diagnostic Systems). The MICs for ciprofloxacin and colistin were also determined by the broth microdilution method according to European Committee on Antimicrobial Susceptibility Testing 2019 guidelines (https://www.sfm-microbiologie.org/2019/05/06/ casfm-eucast-2019-v2/). Strain 18TA was resistant to all tested β-lactams, including carbapenems (Table 1). The strain was also resistant to gentamicin, tobramycin, quinolones (nalidixic acid), fluoroquinolones (cipro-floxacin) and trimethoprim/sulfamethoxazole (SXT) and showed decreased susceptibility to tigecycline (MIC = 2 mg/mL). It remained susceptible to amikacin, fosfomycin and colistin (Table 1). The imipenem/ethylene diamine tetra-acetic acid (EDTA) combined disk diffusion test was positive since the inhibition zone increased by 7 mm with the imipenem/EDTA disk compared with the imipenem disk alone, suggesting the presence of a metallo-β-lactamase (MBL) [1]. In addition, the double-disk synergy test (between amoxicillin/clavulanic acid and broad-spectrum cepha-losporins) showed the presence of an extended-spectrum β-lactamase (ESBL)-producing phenotype (data not shown). The transferability of the β-lactam resistance determinant was assessed by conjugation assay using an azide-resistant (Az R) mutant of Escherichia coli C600 as the recipient strain. Selection was performed on Mueller-Hinton agar plates supplemented with sodium azide (300 mg/mL) and ertapenem (4 mg/mL). A transfer frequency of ca. 10-4 transconjugants per donor was observed. Comparison of MICs between the transconjugant (Tc-18TA) and its recipient strain (C600 Az R) showed increased resistance not only to the tested β-lactams but also to gentamicin, tobramycin and SXT (Table 1). Total genomic DNA of strain 18TA was screened using different multiplex PCR amplifications for various β-lactamase genes (bla TEM-like , bla SHV-like , bla OXA-1-like , bla CTX-M groups 1, 2, 9, 18 and 25, bla OXA-48-like , bla KPC and bla GES and the MBL genes bla VIM , bla IMP and bla NDM) as described previously [2]. Amplification results following agarose gel electrophoresis analysis showed the presence of group 1 bla CTX-M and bla NDM genes together with bla TEM-like , bla SHV-like and bla OXA-1-like genes. Except for the bla SHV gene that was found in strain 18TA but not in the transconjugant Tc-18TA and that was attributed to the chromosomally-encoded species-specific enzyme of K. pneumoniae, the four other β-lactamases were also found in transconjugant Tc-18TA (Table 1). Amplification of the entire bla genes was performed and subsequent sequencing ((Custom DNA sequencing; Eurofins Genomics GmbH, Ebersberg, Germany) showed the presence of the narrow-spectrum β-lactamase genes bla TEM-1B and bla OXA-1 associated with the bla CTX-M-15 ESBL gene and the bla NDM-1 MBL gene both in 18TA and Tc-18TA (Table 1). Furthermore, amplifications searching for aac(3)-IIa (gentamicin and tobramycin resistance) and sul1 and dfrA1 (sulfamethoxazole and trimetho-prim resistance, respectively) were positive both in 18TA and Tc-18TA. These genes were also present in Kp3771, a ST147 NDM-1-producing K. pneumoniae strain recently recovered from a patient hospitalised in an intensive care unit of University Hospital Tahar Sfar in Tunisia [3]. NDM-1-positive K. pneumoniae strains have been previously described in Tunisia, but only from hospitalised patients [1-5]. The current study reports the first description of K. pneumoniae carrying the carbapenemase NDM-1 in the Tunisian community http://dx

A Comprehensive MRI Study of Over 2000 Subjects

The incomplete-hippocampal-inversion (IHI), also known as malrotation, is an atypical anatomical pattern of the hippocampus, which has been reported in healthy subjects in different studies. However, extensive characterization of IHI in a large sample has not yet been performed. Furthermore, it is unclear whether IHI are restricted to the medial-temporal lobe or are associated with more extensive anatomical changes. Here, we studied the characteristics of IHI in a community-based sample of 2008 subjects of the IMAGEN database and their association with extra-hippocampal anatomical variations. The presence of IHI was assessed on T1-weighted anatomical magnetic resonance imaging (MRI) using visual criteria. We assessed the association of IHI with other anatomical changes throughout the brain using automatic morphometry of cortical sulci. We found that IHI were much more frequent in the left hippocampus (left: 17%, right: 6%, χ2−test, p < 10−28). Compared to subjects without IHI, subjects with IHI displayed morphological changes in several sulci located mainly in the limbic lobe. Our results demonstrate that IHI are a common left-sided phenomenon in normal subjects and that they are associated with morphological changes outside the medial temporal lobe

Analyse de la résistance aux antibiotiques chez les entérobactéries et étude d’une potentielle voie alternative aux traitements antibiotiques

The increase of multidrug-resistant bacteria (BMR) to antibiotics is a major public health problem. The first objective of the thesis was to search for the presence of BMR, poorly documented in the community in Tunisia. For the first time, we isolate a Klebsiella pneumoniae belonging to the sequence type ST147 producing carbapenemase NDM-1 in this setting, at Sfax. Our data also indicate an unusually high proportion (47%) of Escherichia coli producing committally two extended-spectrum ß-lactamases. Four of them, with CTX-M-15 and CTX-M-27, are divided into 2 clonal strains of type A-ST617 (2 isolates) and B2-ST131 subclade C2 (2 isolates). All contain a plasmid with the same allelic combination, F31: A4: B1; suggesting a possible dissemination of this replicon. In another study (community-based, Djerba), a multiresistant clonal strain Eh22 of Enterobacter hormaechei, containing a 300 kbp conjugative plasmid of IncHI2, was isolated from 2 patients without apparent epidemiological relationship. The plasmid was sequenced and shows the presence of different resistance genes including 4 genes encoding β-lactamases (blaTEM-1, blaDHA-1, blaCTX-M-3 and blaSHV-12). In a second part, we studied in Eh22, the resistance to colistin (CS), antibiotic of last resort. After selection of an in vitro mutant, we showed for the first time, in Enterobacter spp, that this resistance can be due to a mutation in the gene encoding MgrB, a negative regulator of the 2-component PhoQP system that allows the synthesis of cationic residues on lipopolysaccharide, target of CS. In the last part, bacteriocins-like molecules active on BMR were searched in a collection of Bacillus thurengiensis. One of them, BUPM103, inhibits the growth of BMR. The gene for a potential bacthuricin F103 (11 kDa) was identified by an in silico analysis and it was produced in E. coli. The filtered supernatant secretion showed a growth inhibitory activity against a multiresistant K. pneumoniae, in contrast to control (without secretion). This recombinant bacthuricine could constitute a therapeutic alternative for the BMR treatment.L’augmentation des bactéries multirésistantes (BMR) aux antibiotiques est un problème majeur de santé publique. Le premier objectif de la thèse a été de rechercher la présence, peu documentée, de BMR dans la communauté en Tunisie. Pour la première fois, nous isolons une Klebsiella pneumoniae de séquence type ST147 productrice de la carbapénèmase NDM-1 dans ce milieu, à Sfax. Nos données indiquent aussi une proportion inhabituellement élevée (47%) d’Escherichia coli produisant deux ß-lactamases à spectre élargi. Quatre d’entre eux, avec CTX-M-15 et CTX-M-27, se divisent en 2 souches clonales de type A-ST617 (2 isolats) et B2-ST131 subclade C2 (2 isolats). Toutes contiennent un plasmide avec la même combinaison allélique, F31:A4:B1 ; suggérant une possible dissémination de ce réplicon. Lors d’une autre étude (milieu communautaire, Djerba), une souche clonale Eh22 d’Enterobacter hormaechei multirésistante, contenant un plasmide conjugatif IncHI2 de 300 kpb, a été isolée chez 2 patients sans lien épidémiologique apparent. Le plasmide a été séquencé et montre la présence de différents gènes de résistance incluant 4 gènes codant pour des ß-lactamases (blaTEM-1, blaDHA-1, blaCTX-M-3 et blaSHV-12). Dans une seconde partie, nous avons étudié chez Eh22 la résistance à la colistine (CS), antibiotique de dernier recours. Après avoir sélectionné un mutant in vitro, nous avons montré pour la première fois, chez Enterobacter spp, que cette résistance pouvait être due à une mutation dans le gène codant pour MgrB, un régulateur négatif du système à 2 composants PhoQP qui permet la synthèse de groupements cationiques sur le lipopolysaccharide, cible de la CS. Dans une dernière partie, des molécules de type bactériocines actives sur les BMR ont été recherchées à partir d’une collection de Bacillus thurengiensis. L’une d’elle, BUPM103, inhibe la croissance de BMR. Une analyse in silico a permis d’identifier le gène d’une potentielle bacthuricine F103 (11 kDa) qui a été produite dans E. coli. Le surnageant de sécrétion filtré a montré une activité d’inhibition de la croissance de K. pneumoniae multirésistante, contrairement au contrôle (sans sécrétion). Cette bacthuricine recombinante pourrait constituer une alternative thérapeutique pour le traitement des BMR

Analysis of antibiotic resistance in enterobacteria and study of a potential alternative way to antibiotic treatments

L’augmentation des bactéries multirésistantes (BMR) aux antibiotiques est un problème majeur de santé publique. Le premier objectif de la thèse a été de rechercher la présence, peu documentée, de BMR dans la communauté en Tunisie. Pour la première fois, nous isolons une Klebsiella pneumoniae de séquence type ST147 productrice de la carbapénèmase NDM-1 dans ce milieu, à Sfax. Nos données indiquent aussi une proportion inhabituellement élevée (47%) d’Escherichia coli produisant deux ß-lactamases à spectre élargi. Quatre d’entre eux, avec CTX-M-15 et CTX-M-27, se divisent en 2 souches clonales de type A-ST617 (2 isolats) et B2-ST131 subclade C2 (2 isolats). Toutes contiennent un plasmide avec la même combinaison allélique, F31:A4:B1 ; suggérant une possible dissémination de ce réplicon. Lors d’une autre étude (milieu communautaire, Djerba), une souche clonale Eh22 d’Enterobacter hormaechei multirésistante, contenant un plasmide conjugatif IncHI2 de 300 kpb, a été isolée chez 2 patients sans lien épidémiologique apparent. Le plasmide a été séquencé et montre la présence de différents gènes de résistance incluant 4 gènes codant pour des ß-lactamases (blaTEM-1, blaDHA-1, blaCTX-M-3 et blaSHV-12). Dans une seconde partie, nous avons étudié chez Eh22 la résistance à la colistine (CS), antibiotique de dernier recours. Après avoir sélectionné un mutant in vitro, nous avons montré pour la première fois, chez Enterobacter spp, que cette résistance pouvait être due à une mutation dans le gène codant pour MgrB, un régulateur négatif du système à 2 composants PhoQP qui permet la synthèse de groupements cationiques sur le lipopolysaccharide, cible de la CS. Dans une dernière partie, des molécules de type bactériocines actives sur les BMR ont été recherchées à partir d’une collection de Bacillus thurengiensis. L’une d’elle, BUPM103, inhibe la croissance de BMR. Une analyse in silico a permis d’identifier le gène d’une potentielle bacthuricine F103 (11 kDa) qui a été produite dans E. coli. Le surnageant de sécrétion filtré a montré une activité d’inhibition de la croissance de K. pneumoniae multirésistante, contrairement au contrôle (sans sécrétion). Cette bacthuricine recombinante pourrait constituer une alternative thérapeutique pour le traitement des BMR.The increase of multidrug-resistant bacteria (BMR) to antibiotics is a major public health problem. The first objective of the thesis was to search for the presence of BMR, poorly documented in the community in Tunisia. For the first time, we isolate a Klebsiella pneumoniae belonging to the sequence type ST147 producing carbapenemase NDM-1 in this setting, at Sfax. Our data also indicate an unusually high proportion (47%) of Escherichia coli producing committally two extended-spectrum ß-lactamases. Four of them, with CTX-M-15 and CTX-M-27, are divided into 2 clonal strains of type A-ST617 (2 isolates) and B2-ST131 subclade C2 (2 isolates). All contain a plasmid with the same allelic combination, F31: A4: B1; suggesting a possible dissemination of this replicon. In another study (community-based, Djerba), a multiresistant clonal strain Eh22 of Enterobacter hormaechei, containing a 300 kbp conjugative plasmid of IncHI2, was isolated from 2 patients without apparent epidemiological relationship. The plasmid was sequenced and shows the presence of different resistance genes including 4 genes encoding β-lactamases (blaTEM-1, blaDHA-1, blaCTX-M-3 and blaSHV-12). In a second part, we studied in Eh22, the resistance to colistin (CS), antibiotic of last resort. After selection of an in vitro mutant, we showed for the first time, in Enterobacter spp, that this resistance can be due to a mutation in the gene encoding MgrB, a negative regulator of the 2-component PhoQP system that allows the synthesis of cationic residues on lipopolysaccharide, target of CS. In the last part, bacteriocins-like molecules active on BMR were searched in a collection of Bacillus thurengiensis. One of them, BUPM103, inhibits the growth of BMR. The gene for a potential bacthuricin F103 (11 kDa) was identified by an in silico analysis and it was produced in E. coli. The filtered supernatant secretion showed a growth inhibitory activity against a multiresistant K. pneumoniae, in contrast to control (without secretion). This recombinant bacthuricine could constitute a therapeutic alternative for the BMR treatment

Analysis of antibiotic resistance in enterobacteria and study of a potential alternative way to antibiotic treatments

L’augmentation des bactéries multirésistantes (BMR) aux antibiotiques est un problème majeur de santé publique. Le premier objectif de la thèse a été de rechercher la présence, peu documentée, de BMR dans la communauté en Tunisie. Pour la première fois, nous isolons une Klebsiella pneumoniae de séquence type ST147 productrice de la carbapénèmase NDM-1 dans ce milieu, à Sfax. Nos données indiquent aussi une proportion inhabituellement élevée (47%) d’Escherichia coli produisant deux ß-lactamases à spectre élargi. Quatre d’entre eux, avec CTX-M-15 et CTX-M-27, se divisent en 2 souches clonales de type A-ST617 (2 isolats) et B2-ST131 subclade C2 (2 isolats). Toutes contiennent un plasmide avec la même combinaison allélique, F31:A4:B1 ; suggérant une possible dissémination de ce réplicon. Lors d’une autre étude (milieu communautaire, Djerba), une souche clonale Eh22 d’Enterobacter hormaechei multirésistante, contenant un plasmide conjugatif IncHI2 de 300 kpb, a été isolée chez 2 patients sans lien épidémiologique apparent. Le plasmide a été séquencé et montre la présence de différents gènes de résistance incluant 4 gènes codant pour des ß-lactamases (blaTEM-1, blaDHA-1, blaCTX-M-3 et blaSHV-12). Dans une seconde partie, nous avons étudié chez Eh22 la résistance à la colistine (CS), antibiotique de dernier recours. Après avoir sélectionné un mutant in vitro, nous avons montré pour la première fois, chez Enterobacter spp, que cette résistance pouvait être due à une mutation dans le gène codant pour MgrB, un régulateur négatif du système à 2 composants PhoQP qui permet la synthèse de groupements cationiques sur le lipopolysaccharide, cible de la CS. Dans une dernière partie, des molécules de type bactériocines actives sur les BMR ont été recherchées à partir d’une collection de Bacillus thurengiensis. L’une d’elle, BUPM103, inhibe la croissance de BMR. Une analyse in silico a permis d’identifier le gène d’une potentielle bacthuricine F103 (11 kDa) qui a été produite dans E. coli. Le surnageant de sécrétion filtré a montré une activité d’inhibition de la croissance de K. pneumoniae multirésistante, contrairement au contrôle (sans sécrétion). Cette bacthuricine recombinante pourrait constituer une alternative thérapeutique pour le traitement des BMR.The increase of multidrug-resistant bacteria (BMR) to antibiotics is a major public health problem. The first objective of the thesis was to search for the presence of BMR, poorly documented in the community in Tunisia. For the first time, we isolate a Klebsiella pneumoniae belonging to the sequence type ST147 producing carbapenemase NDM-1 in this setting, at Sfax. Our data also indicate an unusually high proportion (47%) of Escherichia coli producing committally two extended-spectrum ß-lactamases. Four of them, with CTX-M-15 and CTX-M-27, are divided into 2 clonal strains of type A-ST617 (2 isolates) and B2-ST131 subclade C2 (2 isolates). All contain a plasmid with the same allelic combination, F31: A4: B1; suggesting a possible dissemination of this replicon. In another study (community-based, Djerba), a multiresistant clonal strain Eh22 of Enterobacter hormaechei, containing a 300 kbp conjugative plasmid of IncHI2, was isolated from 2 patients without apparent epidemiological relationship. The plasmid was sequenced and shows the presence of different resistance genes including 4 genes encoding β-lactamases (blaTEM-1, blaDHA-1, blaCTX-M-3 and blaSHV-12). In a second part, we studied in Eh22, the resistance to colistin (CS), antibiotic of last resort. After selection of an in vitro mutant, we showed for the first time, in Enterobacter spp, that this resistance can be due to a mutation in the gene encoding MgrB, a negative regulator of the 2-component PhoQP system that allows the synthesis of cationic residues on lipopolysaccharide, target of CS. In the last part, bacteriocins-like molecules active on BMR were searched in a collection of Bacillus thurengiensis. One of them, BUPM103, inhibits the growth of BMR. The gene for a potential bacthuricin F103 (11 kDa) was identified by an in silico analysis and it was produced in E. coli. The filtered supernatant secretion showed a growth inhibitory activity against a multiresistant K. pneumoniae, in contrast to control (without secretion). This recombinant bacthuricine could constitute a therapeutic alternative for the BMR treatment

Detection of extended-spectrum beta-lactamase and scarbapenemase-producing Enterobacteriaceae in Tunisia

The emergence of dramatic urinary tract infections (UTIs) caused by the members of the Enterobacteriales is an important public health problem in the community as well as in Tunisian hospitals. This study aims to investigate the prevalence of extended-spectrum &beta;-lactamase (ESBL) and carbapenemase-producing uropathogenic isolates of Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae).&nbsp;Based on decreased susceptibility to &beta;-lactams antibiotics and analyzed for the presence of ESBL and carbapenemase genes by Real Time- polymerase chain reaction (RT-PCR), 56 uropathogenic isolates of E. coli (n = 36) and K. pneumoniae (n = 20) were confirmed positive for ESBLs. The CTX-M-type &beta;-lactamases were mostly detected in E. coli isolates (21 strains, 58.33% [95% CI 38.09% - 72.06%]) followed by blaSHV-like (18 strains, 50% [95% CI 32.92% - 67.07%]), blaTEM-like and blaCMY-2-like simultaneously (15 strains, 41.67% [95% CI 25.51% - 59.24%]). Furthermore, the RT-PCR system on the K. pneumoniae strains demonstrated that blaSHV-12-like was the most predominant (16 strains, 80% [95% CI 56.33% - 94.26%]) followed by blaTEM-like (14 strains, 70% [95% CI 45.72% - 88.10%]), blaCTX-M belonging to groups 9 and 1 (11 strains, 55% [95% CI 31.52% - 76.94%]) and finally blaCMY-2-like (10 strains, 50% [95% CI 27.19% - 72.80%]). In addition, E. coli and K. pneumoniae strains harbored a carbapenemase gene blaOXA-48-like with 22.2% [95% CI 10.11% - 39.15%]; 20% [95% CI 12.83% - 43.66%], respectively.Our results confirm the need to monitor the resistance to extended-spectrum &beta;-lactams and to carbapenems among enterobacteria in Tunisia

Characterization of Incomplete Hippocampal Inversions in a large dataset of young healthy subjects

International audienceIncomplete hippocampal inversion (IHI) is an atypical anatomical pattern of the hippocampus. It has been mostly described in patients with epilepsy, in particular with malformations of cortical development but also in temporal lobe epilepsy (Baulac et al. 1998; Bernasconi et al. 2005; Bajic et al. 2009), with a prevalence of 30%-50%. However, IHI are also found in healthy subjects, although with an apparently lower frequency (Bajic et al. 2008). A few studies have investigated the prevalence of IHI in subjects without seizures (Gamss et al. 2009; D. Bajic et al. 2008). However, these studies include a small number of subjects leading to an imprecise estimation of the prevalence of IHI, or included patients without epileptic seizures but referred for other neurological conditions. Therefore, the frequency of IHI in healthy subjects remains unclear.The purpose of our study was to investigate the prevalence of IHI in a large population of healthy subjects

Detection of Clones B2-ST131-C2 and A-ST617 in Escherichia coli Producing Both CTX-M-15 and CTX-M-27 from Tunisian Community Patients

During a two-month period (2017&ndash;2018), 336 urine samples positive for Escherichia coli were collected from Tunisian patients. Of the 336 samples, 266 were collected from community patients and 70 from hospital settings. In all, 15 ESBL producers were identified (8 and 7, respectively) and assigned to 13 pulsotypes, including four ESBL-producing E. coli (ESBL-E) with E1 and E2 profiles (2 isolates each) from community patients. The two strains E1 were identified as B2-ST131 subclade C2 and the two isolates E2, A-ST617. The four strains carrying both CTX-M-15 and CTX-M-27, exhibited the multireplicon IncFII/F1A/F1B with the same formula F31:A4:B1. Two isolates with patterns E3 and E4 (Dice coefficient, 78.7%) isolated from community and hospital settings of two geographic areas were assigned to the emerging ST131 C1-M27 subclade and contained the replicon F1:A-:B20. The remaining ESBL-E divided into different sequence types/associated CTX-M: 2 ST131-C2/CTX-M-15 and ST744/CTX-M-55, ST617/CTM-15, ST2973/CTX-M-55, ST6448/CTX-M-15, ST224/CTX-M-15, ST1431/CTX-M-15, and ST38/CTX-M-27, one isolate each. Our study reports for the first time the presence in the Tunisian community of two clones of E. coli, including the virulent clone ST131-C2 harboring both CTX-M-15 and CTX-M-27, and confirms the spread of the emergent clone ST131-C1-M-27, notably in community urinary tract infections