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Recurrent Escherichia coli bacteremia
J N Maslow1, M E Mulligan, R D Arbeit
1Infectious Diseases Section, Veterans Affairs Medical Center, Boston, Massachusetts 02130.
Journal of Clinical Microbiology
|March 1, 1994
Summary
Recurrent Escherichia coli (E. coli) bacteremia is uncommon but occurs in patients with weakened immune systems. Virulent E. coli strains and host defense defects contribute to these recurring bloodstream infections.
Area of Science:
- Infectious Diseases
- Microbiology
- Genetics
Background:
- Escherichia coli (E. coli) is a common cause of gram-negative bacteremia.
- Recurrent E. coli urinary tract infections are documented, but recurrent bacteremia is rare.
- Previous studies have not reported recurrent E. coli bacteremia.
Observation:
- This study identified 5 patients with recurrent E. coli bloodstream infections from 163 bacteremia cases.
- Isolates from recurrent episodes were analyzed using pulsed-field gel electrophoresis (PFGE), ribotyping, and virulence factor assessment.
- Four patients had recurrent bacteremia caused by the same E. coli strain, possessing virulence factors.
Findings:
- The same E. coli strain caused recurrent bacteremia in four patients, indicating persistent infection with virulent isolates.
- One patient experienced recurrent bacteremia with clonally related but distinct E. coli strains lacking virulence factors.
- All five patients had underlying host defense defects, including local, systemic, or combined impairments.
Implications:
- Recurrent E. coli bacteremia is a multifactorial process.
- Impaired host defenses and infection with virulent E. coli isolates are key factors.
- Understanding these factors is crucial for managing recurrent bloodstream infections in vulnerable patients.