Host Characteristics and Bacterial Traits Predict Experimental Virulence for Escherichia coli Bloodstream Isolates From Patients With Urosepsis

Johnson, James R.; Porter, Stephen; Johnston, Brian; Kuskowski, Michael A.; Spurbeck, Rachel R.; Mobley, Harry L. T.; Williamson, Deborah A

doi:10.1093/ofid/ofv083

Cited by 88 publications

(119 citation statements)

References 24 publications

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“…A previous study involving a murine sepsis model found that, among human urosepsis isolates, a group B2 background and specific virulence genes, including several that here were associated with ExPEC status among chicken-source E. coli isolates, were significantly predictive of experimental morbidity and lethality in mice (27). A similar in vivo assessment of the present isolates would be of interest, to confirm that the molecular markers detected here predict extraintestinal virulence in a mammalian host.…”

Section: Discussionsupporting

confidence: 74%

“…This suggests that, to the extent that the molecular markers that we used predict virulence potential in humans (27), label claims such as those that we studied cannot be used to guide selective purchasing choices for consumers who wish to avoid foodborne exposure to virulent E. coli strains.…”

Section: Discussionmentioning

confidence: 99%

“…Isolates that qualified as ExPEC, plus a 2:1 randomly selected comparison set of non-ExPEC isolates, were tested by established PCR-based assays for E. coli phylogroup (A, B1, B2, C, D, E, and F) (32) (33)(34)(35), and 43 additional virulence-associated genes or variants thereof (27). ST131 isolates were additionally assessed for membership in the ST131-H30 subclone and for the (ST131-associated) O25b and O16 rfb variants using established PCR-based assays (4,24).…”

Section: Methodsmentioning

confidence: 99%

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Extraintestinal Pathogenic and Antimicrobial-Resistant Escherichia coli, Including Sequence Type 131 (ST131), from Retail Chicken Breasts in the United States in 2013

Johnson

Porter

Johnston

et al. 2017

Appl Environ Microbiol

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Chicken meat products are hypothesized to be vehicles for transmitting antimicrobial-resistant and extraintestinal pathogenic Escherichia coli (ExPEC) to consumers. To reassess this hypothesis in the current era of heightened concerns about antimicrobial use in food animals, we analyzed 175 chicken-source E. coli isolates from a 2013 Consumer Reports national survey. Isolates were screened by PCR for ExPEC-defining virulence genes. The 25 ExPEC isolates (12% of 175) and a 2:1 randomly selected set of 50 non-ExPEC isolates were assessed for their phylogenetic/ clonal backgrounds and virulence genotypes for comparison with their resistance profiles and the claims on the retail packaging label ("organic," "no antibiotics," and "natural"). Compared with the findings for non-ExPEC isolates, the group of ExPEC isolates had a higher prevalence of phylogroup B2 isolates (44% versus 4%; P Ͻ 0.001) and a lower prevalence of phylogroup A isolates (4% versus 30%; P ϭ 0.001), a higher prevalence of multiple individual virulence genes, higher virulence scores (median, 11 [range, 4 to 16] versus 8 [range, 1 to 14]; P ϭ 0.001), and higher resistance scores (median, 4 [range, 0 to 8] versus 3 [range, 0 to 10]; P Ͻ 0.001). All five isolates of sequence type 131 (ST131) were ExPEC (P ϭ 0.003), were as extensively resistant as the other isolates tested, and had higher virulence scores than the other isolates tested (median, 12 [range, 11 to 13] versus 8 [range, 1 to 16]; P ϭ 0.005). Organic labeling predicted lower resistance scores (median, 2 [range, 0 to 3] versus 4 [range, 0 to 10]; P ϭ 0.008) but no difference in ExPEC status or virulence scores. These findings document a persisting reservoir of extensively antimicrobial-resistant ExPEC isolates, including isolates from ST131, in retail chicken products in the United States, suggesting a potential public health threat.IMPORTANCE We found that among Escherichia coli isolates from retail chicken meat products purchased across the United States in 2013 (many of these isolates being extensively antibiotic resistant), a minority had genetic profiles suggesting an ability to cause extraintestinal infections in humans, such as urinary tract infection, implying a risk of foodborne disease. Although isolates from products labeled "organic" were less extensively antibiotic resistant than other isolates, they did not appear to be less virulent. These findings suggest that retail chicken products in the United States, even if they are labeled "organic," pose a potential health threat to consumers because they are contaminated with extensively antibiotic-resistant and, presumably, virulent E. coli isolates.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Extraintestinal Pathogenic and Antimicrobial-Resistant Escherichia coli, Including Sequence Type 131 (ST131), from Retail Chicken Breasts in the United States in 2013

Johnson

Porter

Johnston

et al. 2017

Appl Environ Microbiol

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“…That is, to the extent that virulence gene content predicts actual virulence potential (27), strains with more extensive virulence gene profiles may be more likely to cause infections and/or to cause more severe infections. As such, the H30 expansion may have both enlarged the resistant population and made it more aggressive, thereby resulting in the double threat of more severe infections that also are harder to treat.…”

Section: Discussionmentioning

confidence: 99%

Epidemic Emergence in the United States of Escherichia coli Sequence Type 131- H 30 (ST131- H 30), 2000 to 2009

Johnson

Porter

Thuras

et al. 2017

Antimicrob Agents Chemother

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The H30 subclone of Escherichia coli sequence type 131 (ST131-H30) has become the leading antimicrobial resistance E. coli lineage in the United States and often exhibits resistance to one or both of the two key antimicrobial classes for treating Gram-negative infections, extended-spectrum cephalosporins (ESCs) and fluoroquinolones (FQs). However, the timing of and reasons for its recent emergence are inadequately defined. Accordingly, from E. coli clinical isolates collected systematically across the United States by the SENTRY Antimicrobial Surveillance Program in 2000, 2003, 2006, and 2009, 234 isolates were selected randomly, stratified by year, within three resistance categories: (i) ESCreduced susceptibility, regardless of FQ phenotype (ESC-RS); (ii) FQ resistance, ESC susceptible (FQ-R); and (iii) FQ susceptible, ESC susceptible (FQ-S). Susceptibility profiles, phylogroup, ST, ST131 subclone, and virulence genotypes were determined, and temporal trends and between-variable associations were assessed statistically. From 2000 to 2006, concurrently with the emergence of ESC-RS and FQ-R strains, the prevalence of (virulence-associated) phylogroup B2 among such strains also rose dramatically, due entirely to rapid emergence of ST131, especially H30. By 2009, H30 was the dominant E. coli lineage overall (22%), accounting for a median of 43% of all single-agent and multidrug resistance (68% for ciprofloxacin). H30's emergence increased the net virulence gene content of resistant (especially FQ-R) isolates, giving stable overall virulence gene scores despite an approximately 4-fold expansion of the historically less virulent resistant population. These findings define more precisely the timing and tempo of H30's emergence in the United States, identify possible reasons for it, and suggest potential consequences, including more frequent and/or aggressive antimicrobialresistant infections.

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“…Minimum inhibitory concentration (MIC) results were interpreted according to the Clinical Laboratory and Standards Institute criteria (Clinical and Laboratory Standards Institute, 2013). In addition, isolates were assessed molecularly for bla CTX-M-15 , major E. coli phylogenetic group (phylogroup) (Clermont et al, 2013), ST or ST complex (STc; as determined by fumC-fimH typing (Weissman et al, 2012), full or partial MLST (Maiden et al, 1998), or STc-specific PCR assays Johnson et al, 2009;Matsumura et al, 2012)), membership in the ST131-H30 clonal subset or its sublineage ST131-H30Rx (Banerjee et al, 2013), O type (O16 and O25b only) (Johnson et al, 2014), and extended virulence genotype (for 50 markers) (Johnson et al, 2015). Resistance scores were defined as the number of antibiotic classes to which an isolate exhibited resistance.…”

Section: Laboratory Analysismentioning

confidence: 99%

Clonal distribution and associated characteristics of Escherichia coli clinical and surveillance isolates from a military medical center

Manges

Mende

Murray

et al. 2017

Diagnostic Microbiology and Infectious Disease

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Host Characteristics and Bacterial Traits Predict Experimental Virulence for Escherichia coli Bloodstream Isolates From Patients With Urosepsis

Abstract: Virulence assessment of 67 E. coli urosepsis isolates in a murine sepsis model in relation to host and bacterial characteristics suggested that host compromise, including older age and urinary tract abnormalities, allows comparatively low-virulence E. coli strains to cause urosepsis.

Cited by 88 publications

References 24 publications

Extraintestinal Pathogenic and Antimicrobial-Resistant Escherichia coli, Including Sequence Type 131 (ST131), from Retail Chicken Breasts in the United States in 2013

Extraintestinal Pathogenic and Antimicrobial-Resistant Escherichia coli, Including Sequence Type 131 (ST131), from Retail Chicken Breasts in the United States in 2013

Epidemic Emergence in the United States of Escherichia coli Sequence Type 131- H 30 (ST131- H 30), 2000 to 2009

Clonal distribution and associated characteristics of Escherichia coli clinical and surveillance isolates from a military medical center

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