title: Impact of virulence genes on sepsis severity and survival in Escherichia coli bacteremia.
abstract: Extraintestinal pathogenic Escherichia coli (ExPEC) are a frequent cause of bacteremia and sepsis, but the role of ExPEC genetic virulence factors (VFs) in sepsis development and outcome is ill-defined. Prospective study including 120 adult patients with E. coli bacteremia to investigate the impact of bacterial and host factors on sepsis severity and mortality. Patients' clinical and demographic data were registered. Phylogenetic background of E. coli isolates was analyzed by SNP pyrosequencing and VFs by PCR. The E. coli isolates presented an epidemic population structure with 6 dominant clones making up to half of the isolates. VF gene profiles were highly diverse. Multivariate analysis for sepsis severity showed that the presence of cnf and blaTEM genes increased the risk of severe illness by 6.75 (95% confidence interval [CI] 1.79-24.71) and 2.59 (95% CI 1.04-6.43) times respectively, while each point in the Pitt score increased the risk by 1.34 (95% CI 1.02-1.76) times. Multivariate analysis for mortality showed that active chemotherapy (OR 17.87, 95% CI 3.35-95.45), McCabe-Jackson Index (OR for rapidly fatal category 120.15, 95% CI 4.19-3446.23), Pitt index (OR 1.78, 95% CI 1.25-2.56) and presence of fyuA gene (OR 8.05, 95% CI 1.37-47.12) were associated to increased mortality while the presence of P fimbriae genes had a protective role (OR 0.094, 95%IC 0.018-0.494). Bacteremic E. coli had a high diversity of genetic backgrounds and VF gene profiles. Bacterial VFs and host determinants had an impact on disease evolution and mortality.
authors: a Unidad de Enfermedades Infecciosas y Microbiología Clínica; Servicio de Medicina Interna ; Hospital Universitario La Paz-IDIPAZ ; Madrid , Spain .
authors: Marta
authors: M
authors: Mora-Rillo
authors: Natalia
authors: N
authors: Fernández-Romero
authors: Carolina
authors: C
authors: Navarro-San Francisco
authors: Jesús
authors: J
authors: Díez-Sebastián
authors: Maria Pilar
authors: MP
authors: Romero-Gómez
authors: Francisco Arnalich
authors: FA
authors: Fernández
authors: Jose Ramon Arribas
authors: JRA
authors: López
authors: Jesús
authors: J
authors: Mingorance
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D001483:Base Sequence; D003428:Cross Infection / Q000382:microbiology; D004269:DNA, Bacterial / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D004926:Escherichia coli / Q000235:genetics / Q000472:pathogenicity*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000473:pathology; D010861:Fimbriae, Bacterial / Q000235:genetics; D005767:Gastrointestinal Diseases / Q000382:microbiology / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome; D037521:Virulence Factors / Q000235:genetics*; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D004269:DNA, Bacterial; D037521:Virulence Factors; D001618:beta-Lactamases
keywords: E coli; bloodstream infection; mortality; outcome; systemic inflammatory response syndrome; virulence factor
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