title: Escherichia coli isolates from patients with bacteremic urinary tract infection are genetically distinct from those derived from sepsis following prostate transrectal biopsy.
abstract: BACKGROUND
  Transrectal ultrasound-guided (TRUS) prostate biopsy is a very common procedure that is generally considered relatively safe. However, severe sepsis can occur after TRUS prostate biopsies, with Escherichia coli being the predominant causative agent. A common perception is that the bacteria that cause post-TRUS prostate biopsy infections originate in the urinary tract, but this view has not been adequately tested. Yet other authors believe on the basis of indirect evidence that the pathogens are introduced into the bloodstream by the biopsy needle after passage through the rectal mucosa.
  
  
  METHODS
  We compared E. coli isolates from male patients with bacteremic urinary tract infection (B-UTI) to isolates of patients with post prostate biopsy sepsis (PPBS), in terms of their sequence types, determined by multi-locus sequence typing (MLST) and their virulence markers.
  
  
  RESULTS
  B-UTI isolates were much richer in virulence genes than were PPBS isolates, supporting the hypothesis that E. coli causing PPBS derive directly from the rectum. Sequence type 131 (ST131) strains and related strain from the ST131 were common (>30%) among the E. coli isolates from PPBS patients as well as from B-UTI patients and all these strains expressed extended spectrum beta-lactamases.
  
  
  CONCLUSIONS
  Our finding supports the hypothesis that E. coli causing PPBS derive directly from the rectum, bypassing the urinary tract, and therefore do not require many of the virulence capabilities necessary for an E. coli strain that must persist in the urinary tract. In light of the increasing prevalence of highly resistant E. coli strains, a new approach for prevention of PPBS is urgently required.
authors.affiliation: Infectious Diseases Unit, E. Wolfson Hospital, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: midan@post.tau.ac.il.
authors.forename: Michael
authors.initials: M
authors.lastname: Dan
authors.affiliation: Department of Molecular Microbiology and Biotechnology, The George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Yair
authors.affiliation: Department of Molecular Microbiology and Biotechnology, The George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Alex
authors.initials: A
authors.lastname: Samosav
authors.affiliation: Infectious Diseases Unit, E. Wolfson Hospital, Holon, Israel.
authors.forename: Tamar
authors.initials: T
authors.lastname: Gottesman
authors.affiliation: Infectious Diseases Unit, E. Wolfson Hospital, Holon, Israel.
authors.forename: Orit
authors.initials: O
authors.lastname: Yossepowitch
authors.affiliation: Microbiology Laboratory, E. Wolfson Hospital, Holon, Israel.
authors.forename: Orna
authors.initials: O
authors.lastname: Harari-Schwartz
authors.affiliation: Department of Urology, E. Wolfson Hospital, Holon, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tsivian
authors.affiliation: Department of Molecular Microbiology and Biotechnology, The George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Schreiber
authors.affiliation: Department of Molecular Microbiology and Biotechnology, The George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Gophna
mesh_terms: D000368:Aged; D001706:Biopsy / Q000009:adverse effects; D004926:Escherichia coli / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000382:microbiology*; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D011472:Prostatitis / Q000150:complications / Q000382:microbiology*; D018805:Sepsis / Q000382:microbiology*; D014552:Urinary Tract Infections / Q000382:microbiology*; D037521:Virulence Factors / Q000235:genetics
chemical_list: D037521:Virulence Factors
keywords: Bacteremia; Bacteremic E. coli; Extra-intestinal pathogenic E. coli; Septicemia