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Background   Escherichia coli (E. coli)  is known to cause urinary tract infection (UTI) and meningitis in neonates, as well as existing as a commensal flora of the human gut. Extended-spectrum β-lactamase (ESBL)-producing  E. coli  has increased in the community with the spread of CTX-M type ESBL-producing sequence type 131 (ST131)-O25- H30Rx E. coli  clone. The role of ESBL-producing  E. coli  in female genital tract infection has not been elucidated. The clinical and molecular features of  E. coli  isolated from community-onset female genital tract infections were evaluated to elucidate the current burden in the community, focusing on the highly virulent and multidrug-resistant ST131 clone.    Methods  We collected and sequenced 91 non-duplicated  E. coli  isolates from the female genital tract of 514 patients with community-onset vaginitis. ESBL genotypes were identified by PCR and confirmed to be ESBL-producers by sequencing methods. ST131 clones were screened by PCR for O16-ST131 and O25b-ST131. Pulsed-field gel electrophoresis (PFGE) and PCR-based replicon typing (PBRT) were conducted in ESBL producers. Independent clinical risk factors associated with acquiring ESBL-producing  E. coli  and ST131 clone were analyzed using multivariate logistic regression analysis.    Results  Of the 514 consecutive specimens obtained from the infected female genital tract, 17.7% (91/514) had  E. coli  infection, of which 19.8% (18/91) were ESBL producers. CTX-M-15 was the most common type ( n  = 15). O25b-ST131 and O16-ST131 clones accounted for 15.4% (14/91) and 6.6% (6/91), respectively. In plasmid analysis, ten isolates succeeded in conjugation and plasmid types were IncFII ( n  = 4), IncFI ( n  = 3), IncI1-Iγ (n = 3) with one non-typable case. Compared to ESBL-nonproducing  E. coli , ESBL-producing  E. coli  acquisition was strongly associated with recurrent vaginitis (OR 40.130; 95% CI 9.980–161.366), UTI (OR 18.915; 95% CI 5.469–65.411), and antibiotics treatment (OR 68.390; 95% CI 14.870–314.531).    Conclusion  A dominant clone of CTX-M type ESBL-producing  E. coli  in conjugative plasmids seems to be circulating in the community and considerable number of ST131  E. coli  in the genital tract of Korean women was noted. Sustained monitoring of molecular epidemiology and control of the high-risk group is needed to prevent ESBL-producing  E. coli  from spreading throughout the community.    Electronic supplementary material  The online version of this article (10.1186/s12879-018-3168-8) contains supplementary material, which is available to authorized users.

bmc infectious diseases

Risk factors and molecular features of sequence type (ST) 131 extended-Spectrum-β-lactamase-producing Escherichia coli in community-onset female genital tract infections