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Escherichia coli ST131 Associated with Increased Mortality in Bloodstream Infections from Urinary Tract Source
Amanda Brumwell1, Granger Sutton2,3, Paul M Lantos1,4
1Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Journal of Clinical Microbiology
|June 20, 2023
Summary
Escherichia coli sequence type 131 (ST131) bloodstream infections (BSI) did not increase overall mortality. However, ST131 BSI from urinary tract sources showed higher mortality, linked to specific virulence genes.
Area of Science:
- Clinical microbiology and infectious diseases.
- Genomics and molecular epidemiology of bacterial pathogens.
Background:
- Escherichia coli sequence type 131 (ST131) is a prevalent multidrug-resistant clone with an incompletely understood clinical impact on bloodstream infections (BSI).
- Understanding the specific risks and outcomes associated with ST131 BSI is crucial for effective patient management and infection control strategies.
Purpose of the Study:
- To define risk factors, clinical outcomes, and bacterial genetics associated with ST131 BSI in adult inpatients.
- To investigate the specific contribution of ST131 to mortality in patients with E. coli bloodstream infections, particularly those originating from the urinary tract.
Main Methods:
- A prospective cohort study of adult inpatients with E. coli BSI was conducted between 2002 and 2015.
- Whole-genome sequencing was performed on collected E. coli isolates to identify ST131 and analyze genetic features.
- Statistical analyses were used to compare clinical outcomes, including in-hospital mortality, between ST131 and non-ST131 BSI groups.
Main Results:
- Of 227 patients, 88 (39%) had ST131 E. coli BSI. Overall in-hospital mortality did not differ significantly between ST131 and non-ST131 BSI groups (20% vs. 18%).
- In patients with BSI from a urinary tract source, ST131 was associated with numerically higher in-hospital mortality (19% vs. 6%) and significantly increased mortality in adjusted analysis (OR 5.85, P=0.02).
- Genomic analysis revealed ST131 isolates predominantly had H4:O25 serotype, more prophages, and carried virulence genes for adhesion, iron acquisition, and toxin production.
Conclusions:
- While ST131 E. coli BSI did not increase overall mortality, it was linked to higher mortality in urinary tract infections, suggesting a specific pathogenic role.
- The distinct genetic repertoire of ST131, including virulence factors, likely contributes to the observed increased mortality in urinary tract source BSIs.
- Further research into ST131 virulence mechanisms is warranted to understand its clinical dominance and inform targeted therapeutic strategies.
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