Related Experiment Video
Updated: Mar 14, 2026
Recurrent Escherichia coli Urinary Tract Infection Triggered by Gardnerella vaginalis Bladder Exposure in Mice
Published on: December 4, 2020
The Niche for Escherichia coli Sequence Type 131 Among Veterans: Urinary Tract Abnormalities and Long-Term Care
Dimitri M Drekonja1, Michael A Kuskowski2, Ruth Anway3
1Infectious Diseases Section; Departments of Medicine.
Abstract:
Antimicrobial resistance among Escherichia coli is increasing, driven largely by the global emergence of sequence type 131 (ST131). However, the clinical significance of ST131 status is unknown. Among veterans, we assessed whether ST131 causes more severe, persistent, or recurrence-prone infections than non-ST131 E. coli. Isolates were assessed by polymerase chain reaction for membership in ST131 and relevant subclones thereof (H30R and H30Rx) and by broth microdilution for susceptibility to 11 antibiotics. Clinical and epidemiological data were systematically abstracted from the medical record. Between-group comparisons were made using t tests and Fisher's exact test. Of the 311 unique E. coli isolates, 61 (19.6%) represented ST131. Of these, most (51 of 61, 83.6%) represented the H30R subclone; only 5 of 51 (9.8%) represented H30Rx. Relative to non-ST131 and non-H30R isolates, neither ST131 nor H30R were associated with more severe disease, worse clinical outcomes, or more robust hosts. Instead, both were more likely to be isolated from patients without manifestations of infection (for ST131, 36.1% vs 21.2% [P = .02]; for H30R, 39% vs 21% [P = .008]) and who had prior healthcare contact or long-term care facility (LTCF) exposure (for ST131, 33% vs 14% [P = .002]; for H30R, 37% vs 14% [P < .001]). Despite a greater likelihood of discordant initial therapy, outcomes did not differ between ST131 and H30R isolates vs other E. coli isolates. Among veterans, ST131 and its H30R subclone were associated with LTCF-exposed hosts but not with worse outcomes.
Insights
Sequence type 131 (ST131) Escherichia coli, a growing threat, does not cause worse infections in veterans. ST131 and its H30R subclone are linked to healthcare exposure, not increased disease severity.
Area of Science:
- Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Antimicrobial resistance in Escherichia coli is rising globally, largely due to the emergence of sequence type 131 (ST131).
- The clinical impact of ST131 infections remains unclear, particularly in specific populations like veterans.
Purpose of the Study:
- To determine if ST131 Escherichia coli causes more severe, persistent, or recurrent infections compared to non-ST131 strains in a veteran population.
- To investigate the association of ST131 and its subclones (H30R, H30Rx) with clinical outcomes and host factors.
Main Methods:
- Polymerase chain reaction was used to identify ST131 and its subclones in 311 unique E. coli isolates.
- Broth microdilution assessed antibiotic susceptibility for 11 antibiotics.
- Clinical and epidemiological data were systematically collected and analyzed using t-tests and Fisher's exact test.
Main Results:
- Of 311 E. coli isolates, 61 (19.6%) were ST131, with most belonging to the H30R subclone (83.6%).
- Neither ST131 nor H30R were associated with more severe disease, worse outcomes, or more robust hosts.
- ST131 and H30R isolates were more frequently found in patients without infection symptoms and with prior healthcare or long-term care facility (LTCF) exposure.
- Despite higher rates of discordant initial therapy for ST131/H30R, overall outcomes did not differ from other E. coli isolates.
Conclusions:
- In the veteran population studied, ST131 and its H30R subclone are linked to hosts with healthcare or LTCF exposure.
- ST131 status was not associated with increased disease severity or poorer clinical outcomes in this cohort.
Related Concept Videos
01:26Urinary Tract Infection I: Introduction
01:25Urinary Tract Infection II: Pathophysiology
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:17Urinary Tract Infection IV: Nursing Management
01:23Stringent Response in E. coli