Escherichia coli phylogeny drives co-amoxiclav resistance through variable expression of TEM-1 beta-lactamase

Matlock W., Rodger G., Pritchard E., Colpus M., Kapel N., Barrett L., Morgan M., Oakley S., Hopkins KL., Roohi A., Karageorgopoulos D., Avison MB., Walker AS., Lipworth S., Stoesser N.

Abstract Co-amoxiclav (amoxicillin and clavulanate) is a commonly used combination antibiotic, with resistance in Escherichia coli associated with increased mortality. The class A beta-lactamase bla TEM-1 is often carried by resistant E. coli but exhibits high phenotypic heterogeneity, complicating genotype-phenotype predictions. We curated a dataset of n = 377 diverse E. coli isolates where the only acquired beta-lactamase was bla TEM-1. We generated hybrid assemblies and co-amoxiclav minimum inhibitory concentrations (MICs), and bla TEM-1 qPCR expression data for a subset (n = 67/377). We first tested whether intrinsic expression of bla TEM-1 varied between E. coli lineages, for example, from regulatory system differences, which are challenging to genomically quantify. Using genotypic features, we built a hierarchical Bayesian model for bla TEM-1 expression, controlling for phylogeny. Expression varied across the phylogeny, with some lineages (phylogroups B1 and C, ST12) expressing bla TEM-1 more than others (phylogroups E and F, ST372). Next, we built a second model to predict isolate MIC from genotypic features, again controlling for phylogeny. Phylogeny alone shifted MIC past the clinical breakpoint in 19% (55/292) of isolates with greater-than-chance probability, mostly representing ST12, ST69 and ST127. A third causal model confirmed that phylogenetic influence on bla TEM-1 expression drove variation in MIC. We speculate that intergenic variation underlies this effect.

DOI

10.1038/s41467-025-63714-6

Type

Journal article

Publisher

Springer Science and Business Media LLC

Publication Date

2025-09-30T00:00:00+00:00

Volume

16

Permalink More information Close