Escherichia coli ST131 Associated with Increased Mortality in Bloodstream Infections from Urinary Tract Source.

Autor:	Brumwell A; Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA., Sutton G; J. Craig Venter Institute, Rockville, Maryland, USA.; Noblis, Inc., Washington, DC, USA., Lantos PM; Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.; Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA., Hoffman K; Nicholas School of the Environment, Duke University, Durham, North Carolina, USA., Ruffin F; Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA., Brinkac L; J. Craig Venter Institute, Rockville, Maryland, USA., Clarke TH; J. Craig Venter Institute, Rockville, Maryland, USA., Adams MD; J. Craig Venter Institute, Rockville, Maryland, USA.; The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA., Fowler VG Jr; Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.; Clinical Research Institute, Durham, North Carolina, USA., Fouts DE; J. Craig Venter Institute, Rockville, Maryland, USA., Thaden JT; Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Jazyk:	angličtina
Zdroj:	Journal of clinical microbiology [J Clin Microbiol] 2023 Jul 20; Vol. 61 (7), pp. e0019923. Date of Electronic Publication: 2023 Jun 20.
DOI:	10.1128/jcm.00199-23
Abstrakt:	Escherichia coli sequence type 131 (ST131) is a globally dominant multidrug-resistant clone, although its clinical impact on patients with bloodstream infection (BSI) is incompletely understood. This study aims to further define the risk factors, clinical outcomes, and bacterial genetics associated with ST131 BSI. A prospectively enrolled cohort study of adult inpatients with E. coli BSI was conducted from 2002 to 2015. Whole-genome sequencing was performed with the E. coli isolates. Of the 227 patients with E. coli BSI in this study, 88 (39%) were infected with ST131. Patients with E. coli ST131 BSI and those with non-ST131 BSI did not differ with respect to in-hospital mortality (17/82 [20%] versus 26/145 [18%]; P = 0.73). However, in patients with BSI from a urinary tract source, ST131 was associated with a numerically higher in-hospital mortality than patients with non-ST131 BSI (8/42 [19%] versus 4/63 [6%]; P = 0.06) and increased mortality in an adjusted analysis (odds ratio of 5.85; 95% confidence interval of 1.44 to 29.49; P = 0.02). Genomic analyses showed that ST131 isolates primarily had an H4:O25 serotype, had a higher number of prophages, and were associated with 11 flexible genomic islands as well as virulence genes involved in adhesion ( papA , kpsM , yfcV , and iha ), iron acquisition ( iucC and iutA ), and toxin production ( usp and sat ). In patients with E. coli BSI from a urinary tract source, ST131 was associated with increased mortality in an adjusted analysis and contained a distinct repertoire of genes influencing pathogenesis. These genes could contribute to the higher mortality observed in patients with ST131 BSI. Competing Interests: The authors declare no conflict of interest.
Databáze:	MEDLINE
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