Escherichia coli ST131 Associated with Increased Mortality in Bloodstream Infections from Urinary Tract Source.

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JGM, Adult, Humans, Escherichia coli, Cohort Studies, Escherichia coli Infections, Urinary Tract, Sepsis, Urinary Tract Infections, Anti-Bacterial Agents, beta-Lactamases

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J Clin Microbiol. 2023;61(7):e0019923







This work was supported in whole or in part with federal funds from the National Institute of Allergy and Infectious Diseases, NIH, Department of Health and Human Services under Award Number U19AI110819 and the CDC Prevention Epicenter Program U54CK000603. V.G.F. was supported by 1R01-AI165671-01. J.T.T. was supported by K08- AI171183-01.


Escherichia coli sequence type 131 (ST131) is a globally dominant multidrug- resistant clone, although its clinical impact on patients with bloodstream infection (BSI) is incompletely understood. This study aims to further define the risk factors, clinical out- comes, and bacterial genetics associated with ST131 BSI. A prospectively enrolled cohort study of adult inpatients with E. coli BSI was conducted from 2002 to 2015. Whole-genome sequencing was performed with the E. coli isolates. Of the 227 patients with E. coli BSI in this study, 88 (39%) were infected with ST131. Patients with E. coli ST131 BSI and those with non-ST131 BSI did not differ with respect to in-hospital mortality (17/82 [20%] versus 26/145 [18%]; P = 0.73). However, in patients with BSI from a urinary tract source, ST131 was associated with a numerically higher in-hospital mortality than patients with non-ST131 BSI (8/42 [19%] versus 4/63 [6%]; P = 0.06) and increased mortality in an adjusted analysis (odds ratio of 5.85; 95% confidence interval of 1.44 to 29.49; P = 0.02). Genomic analyses showed that ST131 isolates primarily had an H4:O25 serotype, had a higher number of pro- phages, and were associated with 11 flexible genomic islands as well as virulence genes involved in adhesion (papA, kpsM, yfcV, and iha), iron acquisition (iucC and iutA), and toxin production (usp and sat). In patients with E. coli BSI from a urinary tract source, ST131 was associated with increased mortality in an adjusted analysis and contained a distinct repertoire of genes influencing pathogenesis. These genes could contribute to the higher mortality observed in patients with ST131 BSI.

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