AUTHOR=Daga Ana Paula , Koga Vanessa Lumi , Soncini João Gabriel Material , de Matos Caroline Martins , Perugini Marcia Regina Eches , Pelisson Marsileni , Kobayashi Renata Katsuko T. , Vespero Eliana Carolina 

TITLE=Escherichia coli Bloodstream Infections in Patients at a University Hospital: Virulence Factors and Clinical Characteristics

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=9

YEAR=2019

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2019.00191

DOI=10.3389/fcimb.2019.00191

ISSN=2235-2988

ABSTRACT=<p>Extraintestinal pathogenic <italic>Escherichia coli</italic> (ExPEC) isolates are responsible for many bloodstream infections. The aim of this study was to characterize <italic>E. coli</italic> isolated from the bloodstreams of patients (<italic>n</italic> = 48) at the University Hospital in Brazil. Epidemiological data were obtained through the analysis of medical records and laboratory tests. By PCR analysis, we investigated the presence of virulence factors (VFs), pathogenicity islands (PAIs), extended-spectrum β-lactamase (ESBL), phylogenetic classifications (A, B1, B2, C, D, E, and F) and molecular genotype by enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR). The mortality analysis showed that 33.3% of the deaths were associated with bacteraemia due to <italic>E. coli</italic> infections; in addition, an age between 60 and 75 years (<italic>p</italic> &lt; 0.001; OR = 6.3[2.1–18.9]) and bacteraemia with an abdominal origin (<italic>p</italic> = 0.02; OR = 5[1.2–20.5]) were risk factors for the severity of the infection. Additionally, the presence of the <italic>afa</italic> gene was associated with mortality due to <italic>E. coli</italic> bacteraemia (<italic>p</italic> = 0.027; OR = 11.4[1.5–85.7]). Immunosuppression (27.1%), intestinal diseases (25.0%) and diabetes (18.8%), were prevalent among patients, and most of the bacteraemia cases were secondary to urinary tract infections (50.0%). The serum resistance gene <italic>tra</italic>T was present in 77.1% of isolates, group capsular 2 (<italic>kpsMT</italic> II) was present in 45.8% and the K5 capsule was present in 20.8% of isolates. The isolates also showed a high prevalence for the siderophore yersiniabactina (<italic>fyu</italic>A) (70.8%) and PAI IV<sub>536</sub> (77.1%). Phylogenetic analysis showed that group B2 (45.8%) was the most prevalent, and was the phylogroup that had a higher prevalence of VFs and PAIs. However, in this study, a considerable number of isolated bacteria were classified as group B1 (18.8%) and as group E (14.6%). Eight (16.7%) isolates were resistant to third and fourth generation cephalosporin and group CTX-M-1 (CTX-M-15) was the most prevalent ESBL type. The molecular genotyping showed two clonal lineages and several isolates that were not related to each other. This study provides additional information on the epidemiological and molecular characteristics of <italic>E. coli</italic> bloodstream infections in Brazil.</p>