大肠杆菌 (Escherichia coli) ST131 与血液中增加的死亡率有关 尿路感染 源
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
概括
大肠杆菌序列131型 (ST131) 血流感染 (BSI) 并没有增加整体死亡率. 然而,来自尿路来源的ST131 BSI的死亡率较高,与特定的毒性基因有关.
科学领域:
- 临床微生物学和传染病.
- 细菌病原体的基因组学和分子流行病学.
背景情况:
- 大肠杆菌序列131型 (ST131) 是一种普遍存在的多抗药克隆,对血液感染 (BSI) 的临床影响尚不完全理解.
- 了解与ST131 BSI相关的特定风险和结果对于有效的患者管理和感染控制策略至关重要.
研究的目的:
- 确定成人住院患者中与ST131 BSI相关的风险因素,临床结果和细菌遗传学.
- 调查ST131对患有大肠杆菌血流感染的患者死亡率的特定贡献,特别是来自尿路的感染.
主要方法:
- 在2002年至2015年期间,对患有大肠杆菌BSI的成年住院患者进行了前性队列研究.
- 在收集的大肠杆菌分离物上进行了全基因组测序,以识别ST131并分析遗传特征.
- 使用统计分析来比较ST131和非ST131BSI组之间的临床结果,包括住院死亡率.
主要成果:
- 在227名患者中,88名 (39%) 患有ST131大肠杆菌BSI. 在ST131和非ST131BSI组之间,总体住院死亡率没有显著差异 (20%对18%).
- 在来自尿路来源的BSI患者中,ST131与数值上更高的住院死亡率 (19%vs. 6%) 和在调整后的分析中显著增加的死亡率有关 (OR5.85,P=0.02).
- 基因组分析显示,ST131分离物主要具有H4:O25血型,更多的prophages,并携带粘附,铁获取和毒素生产的毒性基因.
结论:
- 虽然ST131 E. coli BSI并没有增加整体死亡率,但它与尿路感染的死亡率更高有关,这表明它具有特定的致病作用.
- 包括毒性因子在内的ST131的独特遗传谱,可能有助于观察到尿路来源BSI的死亡率增加.
- 对ST131毒性机制的进一步研究是有必要的,以了解其临床主导地位,并为有针对性的治疗策略提供信息.
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