Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 225, Issue 12, Pages 2197-2207Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jiab638
Keywords
Escherichia coli; intestinal colonization; ST131; fluoroquinolone resistance; virulence factors; surveillance; molecular epidemiology; ecology; multivariable modeling; machine learning
Categories
Funding
- Office of Research and Development, Department of Veterans Affairs [1 I01 CX000920-01, 2I01CX000920-04]
- National Institute of Allergy and Infectious Diseases of the National Institutes of Health Antibacterial Resistance Leadership Group [UM1AI104681]
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This study found that ST131-H30 subclone of Escherichia coli exhibits exceptional intestinal persistence, possibly due to a combination of fluoroquinolone resistance and virulence factors. These findings provide new insights for further study on the pandemic emergence of ST131-H30.
Background Superior gut colonization may underlie the pandemic emergence of the resistance-associated H30 subclone of Escherichia coli sequence type 131 (ST131-H30). Little is known about the associated host and bacterial characteristics, or the comparative persistence of non-ST131 intestinal E. coli. Methods Generic and fluoroquinolone-resistant E. coli isolates from volunteers' serial fecal samples underwent clonal analysis and extensive polymerase chain reaction (PCR)-based characterization (phylogroup, selected sequence types, virulence genes). Kaplan-Meier survival analysis and Cox proportional hazards survival analysis using penalized regression (a machine-learning method) were used to identify correlates of strain persistence. Results Screening of 2005 subjects at the Minneapolis VA Medical Center identified 222 subjects (117 veterans, 105 human and animal household members) for longitudinal fecal surveillance. Analysis of their 585 unique-by-subject fecal E. coli strains identified multiple epidemiological, ecological, and bacterial correlates of strain persistence. ST131-H30, a strong univariable correlate of persistence, was superseded in multivariable analysis by outpatient status, fluoroquinolone resistance, and diverse (predominantly iron uptake-related) virulence genes. Conclusions ST131-H30 exhibits exceptional intestinal persistence, possibly due to a combination of fluoroquinolone resistance and virulence factors, which may be primarily colonization factors. This identifies both likely contributors to the ST131-H30 pandemic and potential targets for interventions against it. During longitudinal fecal surveillance of veterans without current infection and their household members, ST131-H30 exhibited exceptional intestinal persistence, possibly due to a combination of fluoroquinolone resistance and virulence factors, which may be primarily colonization factors.
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