title: Relative fecal abundance of extended-spectrum-β-lactamase-producing Escherichia coli strains and their occurrence in urinary tract infections in women.
abstract: Extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli (ESBL E. coli) strains are of major concern because few antibiotics remain active against these bacteria. We investigated the association between the fecal relative abundance (RA) of ESBL-producing E. coli (ESBL-RA) and the occurrence of ESBL E. coli urinary tract infections (UTIs). The first stool samples passed after suspicion of UTI from 310 women with subsequently confirmed E. coli UTIs were sampled and tested for ESBL-RA by culture on selective agar. Predictive values of ESBL-RA for ESBL E. coli UTI were analyzed for women who were not exposed to antibiotics when the stool was passed. ESBL E. coli isolates were characterized for ESBL type, phylogroup, relatedness, and virulence factors. The prevalence of ESBL E. coli fecal carriage was 20.3%, with ESBL E. coli UTIs being present in 12.3% of the women. The mean ESBL-RA (95% confidence interval [CI]) was 13-fold higher in women exposed to antibiotics at the time of sampling than in those not exposed (14.3% [range, 5.6% to 36.9%] versus 1.1% [range, 0.32% to 3.6%], respectively; P < 0.001) and 18-fold higher in women with ESBL E. coli UTI than in those with another E. coli UTI (10.0% [range, 0.54% to 100%] versus 0.56% [range, 0.15% to 2.1%[, respectively; P < 0.05). An ESBL-RA of <0.1% was 100% predictive of a non-ESBL E. coli UTI. ESBL type, phylogroup, relatedness, and virulence factors were not found to be associated with ESBL-RA. In conclusion, ESBL-RA was linked to the occurrence of ESBL E. coli UTI in women who were not exposed to antibiotics and who had the same clone of E. coli in urine samples and fecal samples. Especially, a low ESBL-RA appeared to be associated with a low risk of ESBL E. coli infection.
authors.affiliation: EA3964, Faculté de Médecine Paris Diderot, Paris, France. etienne.ruppe@gmail.com
authors.forename: Etienne
authors.initials: E
authors.lastname: Ruppé
authors.forename: Brandusa
authors.initials: B
authors.lastname: Lixandru
authors.forename: Radu
authors.initials: R
authors.lastname: Cojocaru
authors.forename: Cagri
authors.initials: C
authors.lastname: Büke
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Paramythiotou
authors.forename: Cécile
authors.initials: C
authors.lastname: Angebault
authors.forename: Claire
authors.initials: C
authors.lastname: Visseaux
authors.forename: Ingrid
authors.initials: I
authors.lastname: Djuikoue
authors.forename: Esra
authors.initials: E
authors.lastname: Erdem
authors.forename: Olga
authors.initials: O
authors.lastname: Burduniuc
authors.forename: Assiya
authors.initials: A
authors.lastname: El Mniai
authors.forename: Candice
authors.initials: C
authors.lastname: Marcel
authors.forename: Marion
authors.initials: M
authors.lastname: Perrier
authors.forename: Thomas
authors.initials: T
authors.lastname: Kesteman
authors.forename: Olivier
authors.initials: O
authors.lastname: Clermont
authors.forename: Erick
authors.initials: E
authors.lastname: Denamur
authors.forename: Laurence
authors.initials: L
authors.lastname: Armand-Lefèvre
authors.forename: Antoine
authors.initials: A
authors.lastname: Andremont
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D058491:Bacterial Load; D015373:Bacterial Typing Techniques; D003430:Cross-Sectional Studies; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics / Q000254:growth & development; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology*; D005243:Feces / Q000382:microbiology*; D005260:Female; D015870:Gene Expression; D006801:Humans; D008875:Middle Aged; D014551:Urinary Tract / Q000382:microbiology*; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology*; D037521:Virulence Factors / Q000378:metabolism; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D037521:Virulence Factors; D001618:beta-Lactamases