Bacterial genotypic and patient risk factors for adverse outcomes in Escherichia coli bloodstream infections: a prospective molecular epidemiological study
| Autor: | Jauneikaite, Elita, Honeyford, Kate, Blandy, Oliver, Mosavie, Mia, Pearson, Max, Ramzan, Farzan A, Ellington, Matthew J, Parkhill, Julian, Costelloe, Céire E, Woodford, Neil, Sriskandan, Shiranee |
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| Přispěvatelé: | Jauneikaite, Elita [0000-0002-7075-6896], Ellington, Matthew J [0000-0002-0656-3360], Sriskandan, Shiranee [0000-0002-5214-4941], Apollo - University of Cambridge Repository, National Institute for Health Research, Medical Research Council (MRC) |
| Rok vydání: | 2022 |
| Předmět: |
Microbiology (medical)
Genotype ENGLAND Bacteremia Microbiology beta-Lactamases EMERGENCE Anti-Infective Agents 1108 Medical Microbiology Risk Factors Drug Resistance Multiple Bacterial Escherichia coli H30 Humans Pharmacology (medical) Pharmacology & Pharmacy POPULATION-STRUCTURE Prospective Studies Escherichia coli Infections Pharmacology Science & Technology ANTIMICROBIAL RESISTANCE Amoxicillin SEQUENCE TYPE 131 TRENDS Anti-Bacterial Agents Infectious Diseases 1115 Pharmacology and Pharmaceutical Sciences Gentamicins Life Sciences & Biomedicine 0605 Microbiology Multilocus Sequence Typing |
| Popis: | Objectives Escherichia coli bloodstream infections have shown a sustained increase in England, for reasons that are unknown. Furthermore, the contribution of MDR lineages such as ST131 to overall E. coli disease burden and outcome is undetermined. Methods We genome-sequenced E. coli blood isolates from all patients with E. coli bacteraemia in north-west London from July 2015 to August 2016 and assigned MLST genotypes, virulence factors and AMR genes to all isolates. Isolate STs were then linked to phenotypic antimicrobial susceptibility, patient demographics and clinical outcome data to explore relationships between the E. coli STs, patient factors and outcomes. Results A total of 551 E. coli genomes were analysed. Four STs (ST131, 21.2%; ST73, 14.5%; ST69, 9.3%; and ST95, 8.2%) accounted for over half of cases. E. coli genotype ST131-C2 was associated with phenotypic non-susceptibility to quinolones, third-generation cephalosporins, amoxicillin, amoxicillin/clavulanic acid, gentamicin and trimethoprim. Among 300 patients from whom outcome was known, an association between the ST131-C2 lineage and longer length of stay was detected, although multivariable regression modelling did not demonstrate an association between E. coli ST and mortality. Several unexpected associations were identified between gentamicin non-susceptibility, ethnicity, sex and adverse outcomes, requiring further research. Conclusions Although E. coli ST was associated with defined antimicrobial non-susceptibility patterns and prolonged length of stay, E. coli ST was not associated with increased mortality. ST131 has outcompeted other lineages in north-west London. Where ST131 is prevalent, caution is required when devising empiric regimens for suspected Gram-negative sepsis, in particular the pairing of β-lactam agents with gentamicin. |
| Databáze: | OpenAIRE |
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