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Leukemia and risk of recurrent Escherichia coli bacteremia: genotyping implicates E. coli translocation from the colon to the bloodstream.

Samet A, Sledzińska A, Krawczyk B, Hellmann A, Nowicki S, Kur J, Nowicki B - Eur. J. Clin. Microbiol. Infect. Dis. (2013)

Bottom Line: In 2005, 6 out of 25 (24 %) patients with leukemia had ≥2 episodes of E. coli-positive blood cultures.These gastrointestinal E. coli isolates were replaced within 3-8 weeks with a new E. coli H genotype.A recurrent episode of bacteremia was usually caused by an infection with a transient E. coli H genotype identical to that found in the subject's bowel.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Clinical Microbiology, Gdańsk University of Medicine, Gdańsk, Poland.

ABSTRACT
In patients with leukemia, the portal(s) and reasons for the persistence of an Escherichia coli recurrent bacteremia remain unclear. Adult Hematology Clinic (AHC) databases at the State Clinical Hospital in Gdańsk were reviewed to evaluate the frequency of E. coli bacteremia between 2002 and 2005. Blood and bowel E. coli strains were obtained and the genetic relatedness of the strains was analyzed. The rate of E. coli bacteremia per 1,000 admissions at the AHC was higher (85.0) than in the other clinics of the hospital (2.9), p < 0.001. A higher mortality was observed in patients with a history of E. coli versus non-E. coli bacteremia [30/95 (31 %) vs. 53/430 (12 %), p < 0.001]; 72.8 % of patients with leukemia had an unknown source of bacteremia. In 2005, 6 out of 25 (24 %) patients with leukemia had ≥2 episodes of E. coli-positive blood cultures. These gastrointestinal E. coli isolates were replaced within 3-8 weeks with a new E. coli H genotype. A recurrent episode of bacteremia was usually caused by an infection with a transient E. coli H genotype identical to that found in the subject's bowel. Consistent with the definition of bowel/blood translocation, the bowel appeared to be a portal for E. coli in these subjects and, hence, a clear source for their recurring bacteremia.

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Related in: MedlinePlus

Polymerase chain reaction melting profiles (PCR MP) fingerprints for representative Escherichia coli isolates from patients of the Adult Hematology Clinic (AHC) ward showing H genotypes from H1 to H20. PCR MP fingerprinting H types are given above each lane. The DNA amplicons were electrophoresed on 6 % polyacrylamide gels
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Fig1: Polymerase chain reaction melting profiles (PCR MP) fingerprints for representative Escherichia coli isolates from patients of the Adult Hematology Clinic (AHC) ward showing H genotypes from H1 to H20. PCR MP fingerprinting H types are given above each lane. The DNA amplicons were electrophoresed on 6 % polyacrylamide gels

Mentions: Since we postulated that the source/portal of recurrent infection would be the bowel, we focused on the similarity of E. coli genotypes in blood and bowel isolates over time. To define whether a recurrence of bacteremia was caused by the same genotype persisting in the bowel as a pathogen (or if the re-infection was caused by a transient new colonizer), we first characterized E. coli DNA fingerprint patterns produced by PCR MP and REA-PFGE. DNA fingerprinting of 65 E. coli isolates from blood and/or bowel identified 32 genotype patterns, which were named H1 to H32 (Fig. 1, representative results by using the PCR MP method). Among the most frequent genotypes, the H2 pattern was represented in nine E. coli isolates, H17 and H22 were represented in six isolates each, and the remaining H types were restricted to one or two E. coli isolates (Table 5). E. coli genotype H2, which represented a nosocomial strain, was identified in the blood cultures of four patients with leukemia. The other frequent genotype (E. coli H22) was isolated from the blood of two patients (P10 and P18). Among the genotypes that were less frequent, E. coli H9, H11, H13, H15, H16, H20m and H30 were isolated from both the blood and the bowel samples (one patient for each genotype), which is consistent with an E. coli isolate H fingerprint specificity.Fig. 1


Leukemia and risk of recurrent Escherichia coli bacteremia: genotyping implicates E. coli translocation from the colon to the bloodstream.

Samet A, Sledzińska A, Krawczyk B, Hellmann A, Nowicki S, Kur J, Nowicki B - Eur. J. Clin. Microbiol. Infect. Dis. (2013)

Polymerase chain reaction melting profiles (PCR MP) fingerprints for representative Escherichia coli isolates from patients of the Adult Hematology Clinic (AHC) ward showing H genotypes from H1 to H20. PCR MP fingerprinting H types are given above each lane. The DNA amplicons were electrophoresed on 6 % polyacrylamide gels
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3824565&req=5

Fig1: Polymerase chain reaction melting profiles (PCR MP) fingerprints for representative Escherichia coli isolates from patients of the Adult Hematology Clinic (AHC) ward showing H genotypes from H1 to H20. PCR MP fingerprinting H types are given above each lane. The DNA amplicons were electrophoresed on 6 % polyacrylamide gels
Mentions: Since we postulated that the source/portal of recurrent infection would be the bowel, we focused on the similarity of E. coli genotypes in blood and bowel isolates over time. To define whether a recurrence of bacteremia was caused by the same genotype persisting in the bowel as a pathogen (or if the re-infection was caused by a transient new colonizer), we first characterized E. coli DNA fingerprint patterns produced by PCR MP and REA-PFGE. DNA fingerprinting of 65 E. coli isolates from blood and/or bowel identified 32 genotype patterns, which were named H1 to H32 (Fig. 1, representative results by using the PCR MP method). Among the most frequent genotypes, the H2 pattern was represented in nine E. coli isolates, H17 and H22 were represented in six isolates each, and the remaining H types were restricted to one or two E. coli isolates (Table 5). E. coli genotype H2, which represented a nosocomial strain, was identified in the blood cultures of four patients with leukemia. The other frequent genotype (E. coli H22) was isolated from the blood of two patients (P10 and P18). Among the genotypes that were less frequent, E. coli H9, H11, H13, H15, H16, H20m and H30 were isolated from both the blood and the bowel samples (one patient for each genotype), which is consistent with an E. coli isolate H fingerprint specificity.Fig. 1

Bottom Line: In 2005, 6 out of 25 (24 %) patients with leukemia had ≥2 episodes of E. coli-positive blood cultures.These gastrointestinal E. coli isolates were replaced within 3-8 weeks with a new E. coli H genotype.A recurrent episode of bacteremia was usually caused by an infection with a transient E. coli H genotype identical to that found in the subject's bowel.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Clinical Microbiology, Gdańsk University of Medicine, Gdańsk, Poland.

ABSTRACT
In patients with leukemia, the portal(s) and reasons for the persistence of an Escherichia coli recurrent bacteremia remain unclear. Adult Hematology Clinic (AHC) databases at the State Clinical Hospital in Gdańsk were reviewed to evaluate the frequency of E. coli bacteremia between 2002 and 2005. Blood and bowel E. coli strains were obtained and the genetic relatedness of the strains was analyzed. The rate of E. coli bacteremia per 1,000 admissions at the AHC was higher (85.0) than in the other clinics of the hospital (2.9), p < 0.001. A higher mortality was observed in patients with a history of E. coli versus non-E. coli bacteremia [30/95 (31 %) vs. 53/430 (12 %), p < 0.001]; 72.8 % of patients with leukemia had an unknown source of bacteremia. In 2005, 6 out of 25 (24 %) patients with leukemia had ≥2 episodes of E. coli-positive blood cultures. These gastrointestinal E. coli isolates were replaced within 3-8 weeks with a new E. coli H genotype. A recurrent episode of bacteremia was usually caused by an infection with a transient E. coli H genotype identical to that found in the subject's bowel. Consistent with the definition of bowel/blood translocation, the bowel appeared to be a portal for E. coli in these subjects and, hence, a clear source for their recurring bacteremia.

Show MeSH
Related in: MedlinePlus