title: The Pandemic H30 Subclone of Escherichia coli Sequence Type 131 Is Associated With Persistent Infections and Adverse Outcomes Independent From Its Multidrug Resistance and Associations With Compromised Hosts.
abstract: The H30 subclone within Escherichia coli sequence type 131 (ST131-H30) has emerged rapidly to become the leading antibiotic-resistant E. coli strain. Hypervirulence, multidrug resistance, and opportunism have been proposed as explanations for its epidemic success.
  
  
  
  We assessed 1133 consecutive unique E. coli clinical isolates from 5 medical centers (2010-2011) for H30 genotype, which we compared with epidemiological and clinical data extracted from medical records by blinded reviewers. Using univariable and multivariable logistic regression analysis, we explored associations of H30 with underlying host characteristics, clinical presentations, management, and outcomes, adjusting for host characteristics.
  
  
  
  The H30 (n = 107) isolates were associated with hosts who were older, male, locally and systemically compromised, and healthcare and antibiotic exposed. With multivariable adjustment for host factors, H30 lost its numerous significant univariable associations with initial clinical presentation, but remained strongly associated with clinical persistence (odds ratio [OR], 3.47; 95% confidence interval [CI], 1.89-6.37), microbiological persistence (OR, 4.46; 95% CI, 2.38-8.38), subsequent hospital admission (OR, 2.68; 95% CI, 1.35-5.33), and subsequent new infection (OR, 1.73; 95% CI, 1.01-3.00). These host-adjusted associations remained strong even with added adjustment for resistance to the initially prescribed antibiotics, and the adverse outcome associations (subsequent hospital admission, new infection) were independent of clinical and microbiological persistence.
  
  
  
  In addition to targeting compromised hosts and resisting multiple antibiotics, H30 isolates may have an intrinsic ability to cause highly persistent infections and later adverse outcomes. The basis for these host- and resistance-independent associations is unclear, but they should be considered when managing patients with H30 infections.
authors.affiliation: Veterans Affairs Medical Center.|University of Minnesota, Minneapolis.
authors.forename: James R
authors.initials: JR
authors.lastname: Johnson
authors.affiliation: Veterans Affairs Medical Center.|University of Minnesota, Minneapolis.
authors.forename: Paul
authors.initials: P
authors.lastname: Thuras
authors.affiliation: Veterans Affairs Medical Center.|University of Minnesota, Minneapolis.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Johnston
authors.affiliation: University of Washington.|Seattle Children's Hospital.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Weissman
authors.affiliation: University of Washington.
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.affiliation: Group Health Cooperative, Seattle, Washington.
authors.forename: Kim
authors.initials: K
authors.lastname: Riddell
authors.affiliation: University of Washington.|Group Health Cooperative, Seattle, Washington.
authors.forename: Delia
authors.initials: D
authors.lastname: Scholes
authors.affiliation: University of Washington.
authors.forename: Veronika
authors.initials: V
authors.lastname: Tchesnokova
authors.affiliation: University of Washington.
authors.forename: Evgeni
authors.initials: E
authors.lastname: Sokurenko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000235:genetics*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Escherichia coli infections; ST131; antimicrobial resistance; host compromise; long-term care