The Niche for Escherichia coli Sequence Type 131 Among Veterans: Urinary Tract Abnormalities and Long-Term Care Facilities.
The Niche for Escherichia coli Sequence Type 131 Among Veterans: Urinary Tract Abnormalities and Long-Term Care Facilities.
复制标题
DOI：
10.1093/ofid/ofw138
复制
发表时间：
2016-09
影响因子：
4.2
通讯作者：
Johnson JR
中科院分区：
文献类型：
--
作者：
Drekonja DM;Kuskowski MA;Anway R;Johnston BD;Johnson JR
尽管存在更广泛的抗菌素耐药性和毒力决定因素特征，但在退伍军人中，与其他大肠杆菌相比，131 型大肠杆菌序列及其 H30R 亚克隆与相似的结果相关，并且与尿路异常和长期护理机构暴露相关。背景。 大肠杆菌的抗菌素耐药性正在增加，这主要是由于序列类型 131 (ST131) 在全球的出现。然而，ST131 状态的临床意义尚不清楚。在退伍军人中，我们评估了 ST131 是否会比非 ST131 大肠杆菌引起更严重、持续或更容易复发的感染。方法。 通过聚合酶链反应评估分离株在 ST131 及其相关亚克隆（H30R 和 H30Rx）中的成员资格，并通过微量肉汤稀释评估分离株对 11 种抗生素的敏感性。从病历中系统地提取临床和流行病学数据。使用t检验和Fisher精确检验进行组间比较。结果。 在 311 种独特的大肠杆菌分离株中，61 种 (19.6%) 代表 ST131。其中，大多数（61 个中的 51 个，83.6%）代表 H30R 亚克隆； 51 名中只有 5 名 (9.8%) 代表 H30Rx。相对于非 ST131 和非 H30R 分离株，ST131 和 H30R 均不与更严重的疾病、更差的临床结果或更强壮的宿主相关。相反，两者都更有可能与没有感染表现的患者隔离（对于 ST131，36.1% vs 21.2% [P = .02]；对于 H30R，39% vs 21% [P = .008]）以及之前曾接触过医疗保健人员或长期护理机构 (LTCF) 的患者（对于 ST131，33% vs 14% [P = .002]；对于 H30R，分别为 33% vs 14% [P = .002]） H30R，37% 与 14% [P < .001]）。尽管初始治疗不一致的可能性更大，但 ST131 和 H30R 分离株与其他大肠杆菌分离株之间的结果没有差异。结论。 在退伍军人中，ST131 及其 H30R 亚克隆与暴露于 LTCF 的宿主相关，但与更差的结果无关。
Despite more extensive antimicrobial resistance and virulence determinant profiles, among veterans Escherichia coli sequence type 131 and its H30R subclone are associated with similar outcomes compared to other E. coli, and with urinary tract abnormalities and long-term care facility exposure. Background. Antimicrobial resistance among Escherichia coli is increasing, driven largely by the global emergence of sequence type 131 (ST131). However, the clinical significance of ST131 status is unknown. Among veterans, we assessed whether ST131 causes more severe, persistent, or recurrence-prone infections than non-ST131 E. coli. Methods. Isolates were assessed by polymerase chain reaction for membership in ST131 and relevant subclones thereof (H30R and H30Rx) and by broth microdilution for susceptibility to 11 antibiotics. Clinical and epidemiological data were systematically abstracted from the medical record. Between-group comparisons were made using t tests and Fisher's exact test. Results. Of the 311 unique E. coli isolates, 61 (19.6%) represented ST131. Of these, most (51 of 61, 83.6%) represented the H30R subclone; only 5 of 51 (9.8%) represented H30Rx. Relative to non-ST131 and non-H30R isolates, neither ST131 nor H30R were associated with more severe disease, worse clinical outcomes, or more robust hosts. Instead, both were more likely to be isolated from patients without manifestations of infection (for ST131, 36.1% vs 21.2% [P = .02]; for H30R, 39% vs 21% [P = .008]) and who had prior healthcare contact or long-term care facility (LTCF) exposure (for ST131, 33% vs 14% [P = .002]; for H30R, 37% vs 14% [P < .001]). Despite a greater likelihood of discordant initial therapy, outcomes did not differ between ST131 and H30R isolates vs other E. coli isolates. Conclusions. Among veterans, ST131 and its H30R subclone were associated with LTCF-exposed hosts but not with worse outcomes.
登录
查看更多内容
影响因子：
9.4
作者：
Johnson, James R.;Clermont, Olivier;Denamur, Erick
通讯作者：
Denamur, Erick
影响因子：
4.5
作者：
Banerjee, Ritu;Johnston, Brian;Johnson, James R.
通讯作者：
Johnson, James R.
影响因子：
5.2
作者：
Ciesielczuk, Holly;Betts, Jonathon;Wareham, David W.
通讯作者：
Wareham, David W.
影响因子：
9.4
作者：
Owens, Robert C., Jr.;Johnson, James R.;Quinn, John
通讯作者：
Quinn, John
影响因子：
4.2
作者：
Burgess, Mary J.;Johnson, James R.;Banerjee, Ritu
通讯作者：
Banerjee, Ritu