Clinical Characteristics of Patients and Whole Genome Sequencing-Based Surveillance of Escherichia coli Community-Onset Bloodstream Infections at a Non-tertiary Hospital in CHINA.

Fenghong Chen,Yunbo Chen,Aizhi Chen,Tao Lv,Yonghong Xiao,Yupeng Xiao

doi:10.3389/fmicb.2021.748471

Abstract

Background: Escherichia coli is the most common pathogens in patients with community-onset blood stream infections (COBSI). Knowledge of the epidemiology of this disease is crucial to improve allocation of health resources, formulate isolation strategies that prevent transmission, and guide empirical antibiotic therapy.Methods: This retrospective observational study examined patients with E. coli COBSI (EC-COBSI) at a non-tertiary hospital in China. Whole-genome sequencing and analysis of the isolates was performed. The relationships of clinical variables with antimicrobial resistance and the genetic background of the isolates were examined.Results: There were 148 isolates in patients with EC-COBSI. All isolates were susceptible to ceftazidime/avibactam, carbapenems, and tigecycline; 35.1% were positive for extended spectrum β-lactamase (ESBL+); and blaCTX–M–14 was the most common ESBL gene. Patients with ESBL- isolates were more likely to receive appropriate empiric treatment than those with ESBL+ isolates (61.5% vs. 91.4%, p < 0.001), but these two groups had similar mortality rates. The overall 30-day mortality rate was 9.5%. Phylogenetic analysis showed that the isolates were diverse, and that the main sequence types (STs) were ST95, ST131, and ST69. Intra-abdominal infection was the primary source of disease, and isolates from these patients had lower frequencies of virulence genes.Conclusion: The mortality rate of patients with EC-COBSI was unrelated to ESBL status of the isolates. Most isolates had low resistance to most of the tested antimicrobial agents. The isolates were diverse, and multiple strains were related. Prevention and control of EC-COBSI should target prevention of patient colonization and the living environment.

Highlights

The SENTRY program was established in 1997 to monitor the predominant bacterial pathogens and the antimicrobial resistance patterns of organisms isolated from patients with various types of infections, including bloodstream infection (BSI) (Diekema et al, 2000)
The results indicated that Escherichia coli was the most common species isolated from patients with community-onset bloodstream infections (COBSI) (Diekema et al, 2019) since 2005, consistent with studies from other regions (Bou-Antoun et al, 2016), including China (Quan et al, 2017)
The results demonstrated that the mortality rate from EC-COBSI in our study population was unrelated to ESBL positivity, and that isolates from intra-abdominal infection (IAI) were more genetically diverse than those from the other sources

Summary

Introduction

The SENTRY program was established in 1997 to monitor the predominant bacterial pathogens and the antimicrobial resistance patterns of organisms isolated from patients with various types of infections, including bloodstream infection (BSI) (Diekema et al, 2000). The results indicated that Escherichia coli was the most common species isolated from patients with community-onset bloodstream infections (COBSI) (Diekema et al, 2019) since 2005, consistent with studies from other regions (Bou-Antoun et al, 2016), including China (Quan et al, 2017). Several previous studies focused on drugresistant strains, such as extended spectrum β-lactamase (ESBL) -producing E. coli isolates (Quan et al, 2017), but this may have led to over- or underrepresentation of certain clonal groups. Escherichia coli is the most common pathogens in patients with community-onset blood stream infections (COBSI). Knowledge of the epidemiology of this disease is crucial to improve allocation of health resources, formulate isolation strategies that prevent transmission, and guide empirical antibiotic therapy

Methods

Results

Discussion

Conclusion