Abstract
We conducted a survey including 3334 bloodstream infections (BSIs) due to E. coli diagnosed in 2005–2014 at a stable cohort of hospitals. Marked increases in incidence were observed for community-acquired (CA) BSIs in patients aged >75 years, CA-BSIs of digestive origin in patients aged 60–74 years, healthcare-associated BSIs, and BSIs associated with ESBL (extended-spectrum B-lactamase)-producing E. coli (ESBLEc). Using MLST, we studied the genetic diversity of 412 BSI isolates recovered during the 2014 survey: 7 major sequence type complexes (STCs) were revealed in phylogenetic group B2, 3 in group A/B1 and 2 in group D. Among the 31 ESBLEc isolates, 1/3 belonged to STC 131. We searched for possible associations between clonal groups, clinical determinants and characteristics of BSIs: isolates from groups B2 (except STC 131) and D were susceptible to antibiotics and associated with BSIs of urinary origin in patients <60 years. STC 131 and group A/B1 isolates were multi-drug resistant and associated with CA-BSIs of digestive origin in patients aged 60–74 with a recent history of antibiotic treatment. STC 131 isolates were associated with HCA-BSIs in patients with recent/present hospitalization in a long-stay unit. We provide a unique population-based picture of the epidemiology of E. coli BSI. The aging nature of the population led to an increase in the number of cases caused by the B2 and D isolates generally implicated in BSIs. In addition, the association of a trend toward increasing rates of gut colonization with multi drug-resistant isolates revealed by the rise in the incidence of BSIs of digestive origin caused by STC 131 and A/B1 (STCs 10, 23, and 155) isolates, and a significant increase in the frequency of BSIs in elderly patients with recent antibiotic treatment suggested that antibiotic use may have contributed to the growing incidence of BSI.
Highlights
Various networks recently reported changes in the epidemiological features of E. coli infections in humans, showing an increase in the incidence of bloodstream infections (BSIs) (Laupland, 2013; Williamson et al, 2013; Lai et al, 2014)
Using MLST, we studied the genetic diversity of 412 BSI isolates recovered during the survey: 7 major sequence type complexes (STCs) were revealed in phylogenetic group B2, 3 in group A/B1 and 2 in group D
Matches between isolates recovered from food animals and clinical isolates have suggested that the food animal reservoir may have contributed to the observed epidemiological changes in human infections (Manges et al, 2001; Vincent et al, 2010; Lazarus et al, 2015)
Summary
Various networks recently reported changes in the epidemiological features of E. coli infections in humans, showing an increase in the incidence of BSIs (Laupland, 2013; Williamson et al, 2013; Lai et al, 2014). Matches between isolates recovered from food animals and clinical isolates have suggested that the food animal reservoir may have contributed to the observed epidemiological changes in human infections (Manges et al, 2001; Vincent et al, 2010; Lazarus et al., 2015). The infection control network of the Centre region of France annually conducts a prospective longitudinal BSI survey, to investigate the overall incidence of BSIs in the population and to improve our understanding of the course of these infections. We examined regional trends in the incidence of particular subgroups of BSIs (i.e., CA- and HCABSIs, BSIs of digestive or urinary origin, and BSIs associated with ESBL-producing isolates).
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