title: Bacterial characteristics in relation to clinical source of Escherichia coli isolates from women with acute cystitis or pyelonephritis and uninfected women.
abstract: Characteristics differentiating Escherichia coli strains that cause cystitis or pyelonephritis from fecal E. coli remain incompletely defined, particularly among adult women in the United States. Accordingly, phylogenetic group, O antigens, and virulence factors (VFs) were analyzed among 329 E. coli isolates from the mid-to-late 1990s from women in the United States with acute pyelonephritis (n = 170), cystitis (n = 83), or no infection (fecal; n = 76). Compared with fecal and cystitis isolates, pyelonephritis isolates exhibited a greater prevalence of phylogenetic group B2, most virulence-associated O antigens, and most VFs and had higher VF scores. In contrast, cystitis and fecal isolates differed minimally. By stepwise multivariable logistic regression, significant (P < or = 0.015) predictors of cystitis and/or pyelonephritis (versus fecal) included afa/dra (Dr-binding adhesins), ibeA (invasion of brain endothelium), iha (putative adhesin-siderophore), malX (pathogenicity island marker), the O75 antigen, papEF (P fimbriae), papG allele II (P adhesin variant), group B2, and sfa/foc (S and F1C fimbriae). However, virulence profiles overlapped considerably among source groups and varied greatly within each group. E. coli "clonal group A" (CGA) and the O2:K5/K7:H1 and O75:K+ clonal groups were significantly associated with cystitis and/or pyelonephritis. These findings identify potential vaccine targets, suggest that urovirulence is multiply determined, and confirm the urovirulence of specific E. coli clonal groups, including recently recognized CGA.
authors.affiliation: Infectious Diseases (111F), Minneapolis VA Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, USA. johns007@umn.edu
authors.forename: James R
authors.initials: JR
authors.lastname: Johnson
authors.forename: Krista
authors.initials: K
authors.lastname: Owens
authors.forename: Abby
authors.initials: A
authors.lastname: Gajewski
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuskowski
mesh_terms: D000208:Acute Disease; D003556:Cystitis / Q000382:microbiology*; D004926:Escherichia coli / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000382:microbiology*; D029968:Escherichia coli Proteins / Q000235:genetics; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D019081:O Antigens; D010802:Phylogeny; D015995:Prevalence; D011704:Pyelonephritis / Q000382:microbiology*; D012703:Serotyping; D014556:Urine / Q000382:microbiology; D014774:Virulence; D037521:Virulence Factors / Q000235:genetics
chemical_list: D029968:Escherichia coli Proteins; D019081:O Antigens; D037521:Virulence Factors