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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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Representative results of monitoring the spread of bacteria within patients by using the PCR MP technique. The isolates shown represent three patients: genotype H11 from patient P5, genotype H20 from patient P9, and genotype H22 from patient P18. Lanes marked by numbers indicate the number of the isolate shown in Table 5. Lanes marked by B and S contain strains isolated from blood and stool, respectively. The DNA amplicons were electrophoresed on 6 % polyacrylamide gels
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Fig2: Representative results of monitoring the spread of bacteria within patients by using the PCR MP technique. The isolates shown represent three patients: genotype H11 from patient P5, genotype H20 from patient P9, and genotype H22 from patient P18. Lanes marked by numbers indicate the number of the isolate shown in Table 5. Lanes marked by B and S contain strains isolated from blood and stool, respectively. The DNA amplicons were electrophoresed on 6 % polyacrylamide gels

Mentions: Figure 2 presents examples of E. coli H fingerprints showing identical DNA patterns of isolates from the bowel and the blood. For example, patient P5 had a blood and bowel culture positive for E. coli H11. Patient P1 showed several episodes of bacteremia and identical blood and bowel E. coli, suggesting that a different E. coli inhabitant of the bowel translocated to the bloodstream. Patient P1 was hospitalized six times between September 9th 2004 and September 30, 2005, and spent a total of 236 days in the hospital due to a recurrent E. coli bacteremia with multiple E. coli isolates/H fingerprints, with identical E. coli isolates/H fingerprints identified in the bowel and with no evidence of another obvious source of infection (Table 5). Five blood cultures obtained within the above-mentioned period were positive for E. coli. E. coli isolated from blood and stool (cultures done on same day, May 10th) showed an identical H16 genotype. Following episodes of bacteremia (May 22nd, 25th, and 27th, and August 7th) were caused by an ESBL E. coli H17 genotype. This E. coli H17 was isolated from the patient’s urine on June 20th and from his stool on August 7th. Following bone marrow transplant, the patient received ciprofloxacin, and beginning May 9th, he was treated with piperacillin, tazobactam, and amikacin. Once a positive result of ESBL E. coli isolated from blood was obtained, an additional antibiotic (meropenem) was added to the therapeutic strategy and continued until July 6th, 2005. Thus, in our select patient, the E. coli H genotype that caused bacteremia was eliminated from the vascular bed following antibiotic treatment. After an asymptomatic period, the infection was replaced with another rare E. coli H genotype identical to that identified in the bowel at the time. In agreement with the established bacteriologic and DNA fingerprinting criteria for translocation, in the absence of an alternative source of infection in these patients, recurrent E. coli bacteremia resulted from E. coli translocation from the bowel to the bloodstream.Fig. 2


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)

Representative results of monitoring the spread of bacteria within patients by using the PCR MP technique. The isolates shown represent three patients: genotype H11 from patient P5, genotype H20 from patient P9, and genotype H22 from patient P18. Lanes marked by numbers indicate the number of the isolate shown in Table 5. Lanes marked by B and S contain strains isolated from blood and stool, respectively. 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

Fig2: Representative results of monitoring the spread of bacteria within patients by using the PCR MP technique. The isolates shown represent three patients: genotype H11 from patient P5, genotype H20 from patient P9, and genotype H22 from patient P18. Lanes marked by numbers indicate the number of the isolate shown in Table 5. Lanes marked by B and S contain strains isolated from blood and stool, respectively. The DNA amplicons were electrophoresed on 6 % polyacrylamide gels
Mentions: Figure 2 presents examples of E. coli H fingerprints showing identical DNA patterns of isolates from the bowel and the blood. For example, patient P5 had a blood and bowel culture positive for E. coli H11. Patient P1 showed several episodes of bacteremia and identical blood and bowel E. coli, suggesting that a different E. coli inhabitant of the bowel translocated to the bloodstream. Patient P1 was hospitalized six times between September 9th 2004 and September 30, 2005, and spent a total of 236 days in the hospital due to a recurrent E. coli bacteremia with multiple E. coli isolates/H fingerprints, with identical E. coli isolates/H fingerprints identified in the bowel and with no evidence of another obvious source of infection (Table 5). Five blood cultures obtained within the above-mentioned period were positive for E. coli. E. coli isolated from blood and stool (cultures done on same day, May 10th) showed an identical H16 genotype. Following episodes of bacteremia (May 22nd, 25th, and 27th, and August 7th) were caused by an ESBL E. coli H17 genotype. This E. coli H17 was isolated from the patient’s urine on June 20th and from his stool on August 7th. Following bone marrow transplant, the patient received ciprofloxacin, and beginning May 9th, he was treated with piperacillin, tazobactam, and amikacin. Once a positive result of ESBL E. coli isolated from blood was obtained, an additional antibiotic (meropenem) was added to the therapeutic strategy and continued until July 6th, 2005. Thus, in our select patient, the E. coli H genotype that caused bacteremia was eliminated from the vascular bed following antibiotic treatment. After an asymptomatic period, the infection was replaced with another rare E. coli H genotype identical to that identified in the bowel at the time. In agreement with the established bacteriologic and DNA fingerprinting criteria for translocation, in the absence of an alternative source of infection in these patients, recurrent E. coli bacteremia resulted from E. coli translocation from the bowel to the bloodstream.Fig. 2

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