Bacterial genotypic and patient risk factors for adverse outcomes in Escherichia coli bloodstream infections: a prospective molecular-epidemiological study
Author(s)
Type
Journal Article
Abstract
Objectives:
Escherichia coli bloodstream infections have shown a sustained increase in England, for reasons that are unknown. Furthermore, the contribution of multi-drug resistant 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 multi-locus sequence types, virulence factors, and AMR genes to all isolates. Isolate sequence types were then linked to phenotypic antimicrobial susceptibility, patient demographic, and clinical outcome data to explore relationships between the E. coli sequence types, patient factors, and outcomes.
Results:
A total of 551 E. coli genomes were analysed. Four sequence types (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 sequence type and mortality. Several unexpected associations were identified between gentamicin non-susceptibility; ethnicity; sex and adverse outcomes, requiring further research.
Conclusions:
Although E. coli sequence type was associated with defined antimicrobial non-susceptibility patterns and prolonged length-of-stay, E. coli sequence type 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 beta-lactam agents with gentamicin.
Escherichia coli bloodstream infections have shown a sustained increase in England, for reasons that are unknown. Furthermore, the contribution of multi-drug resistant 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 multi-locus sequence types, virulence factors, and AMR genes to all isolates. Isolate sequence types were then linked to phenotypic antimicrobial susceptibility, patient demographic, and clinical outcome data to explore relationships between the E. coli sequence types, patient factors, and outcomes.
Results:
A total of 551 E. coli genomes were analysed. Four sequence types (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 sequence type and mortality. Several unexpected associations were identified between gentamicin non-susceptibility; ethnicity; sex and adverse outcomes, requiring further research.
Conclusions:
Although E. coli sequence type was associated with defined antimicrobial non-susceptibility patterns and prolonged length-of-stay, E. coli sequence type 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 beta-lactam agents with gentamicin.
Date Issued
2022-06
Date Acceptance
2022-02-07
Citation
Journal of Antimicrobial Chemotherapy, 2022, 77 (6), pp.1753-1761
ISSN
0305-7453
Publisher
Oxford University Press
Start Page
1753
End Page
1761
Journal / Book Title
Journal of Antimicrobial Chemotherapy
Volume
77
Issue
6
Copyright Statement
© The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
License URL
Sponsor
National Institute for Health Research
National Institute for Health Research
Medical Research Council (MRC)
Identifier
https://academic.oup.com/jac/article/77/6/1753/6546015
Grant Number
HPRU-2012-10047
HPRU-2012-10047
MR/R015600/1
Subjects
Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Microbiology
Pharmacology & Pharmacy
SEQUENCE TYPE 131
ANTIMICROBIAL RESISTANCE
POPULATION-STRUCTURE
BACTEREMIA
EMERGENCE
ENGLAND
TRENDS
H30
Amoxicillin
Anti-Bacterial Agents
Anti-Infective Agents
Bacteremia
Drug Resistance, Multiple, Bacterial
Escherichia coli
Escherichia coli Infections
Genotype
Gentamicins
Humans
Multilocus Sequence Typing
Prospective Studies
Risk Factors
beta-Lactamases
Humans
Escherichia coli
Bacteremia
Escherichia coli Infections
Amoxicillin
beta-Lactamases
Gentamicins
Anti-Infective Agents
Anti-Bacterial Agents
Risk Factors
Prospective Studies
Drug Resistance, Multiple, Bacterial
Genotype
Multilocus Sequence Typing
Microbiology
0605 Microbiology
1108 Medical Microbiology
1115 Pharmacology and Pharmaceutical Sciences
Publication Status
Published
Date Publish Online
2022-03-10