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Maghembe RS, Magulye MA, Eilu E, Sekyanzi S, Mwesigwa S, Katagirya E. Chromosomal and plasmid-encoded virulence and multidrug resistance of Escherichia coli ST58/24 infecting a 2-year-old sickle cell patient with sepsis in Kampala Uganda, East Africa. Heliyon 2024; 10:e30187. [PMID: 38707307 PMCID: PMC11068601 DOI: 10.1016/j.heliyon.2024.e30187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
Sepsis and drug resistance represent a complex of the most common global causes of mortality in intensive care units (ICUs) especially among patients with comorbidities. Extraintestinal pathogenic Escherichia coli (ExPEC) strains are highly implicated in systemic infections, with multidrug resistance exacerbating the risk of chronic conditions and patient mortality. The diversity of virulence and evolution of multidrug resistance are yet to be fully deciphered. In this work, we aimed at unveiling the pathogens and their genomic determinants of virulence and drug resistance relevant to increased sepsis in a sickle cell child admitted to ICU. From a rectal swab, we isolated a strain of E. coli from the patient and phenotypically tested it against a panel of selected beta lactams, fluoroquinolones, macrolides, aminoglycosides and colistin. We then sequenced the entire genome and integrated multiple bioinformatic pipelines to divulge the virulence and multidrug resistance profiles of the isolate. Our results revealed that the isolate belongs to the sequence type (ST) 58/24, which (ST58), is a known ExPEC. With the use of PathogenFinder, we were able to confirm that this isolate is a human pathogen (p = 0.936). The assembled chromosome and two plasmids encode virulence factors related to capsule (antiphagocytosis), serum survival and resistance, type 6 secretion system (T6SS), multiple siderophores (iron acquisition), and biosynthetic gene clusters for polyketides and nonribosomal peptides exhibiting host cell damaging activity in silico. The genome also harbors multidrug resistance genotypes including extended spectrum beta lactamase (ESBL) genes such as blaTEM-1A/B, sulfonamide resistance genes sul1/2, fluoroquinolone resistance genes dfrA5 and nonsynonymous mutations of the gene pmrB, conferring intrinsic colistin resistance. Conclusively, this pathogen holds the potential to cause systemic infection and might exacerbate sickle cell anemia in the patient. The virulence and multidrug resistance profiles are encoded by both the chromosome and plasmids. Genomic surveillance of pathogens with multidrug resistance among patients with commodities is crucial for effective disease management.
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Affiliation(s)
- Reuben S. Maghembe
- Department of Microbiologgy and Immunology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Ishaka, Uganda
- Department of Health and Biomedical Sciences, Didia Education and Health Organization, P. O. Box 113, Shinyanga, Tanzania
- Biological and Marine Sciences Unit, Faculty of Natural and Applied Sciences, Marian University College, P. O. Box 47, Bagamoyo, Tanzania
- Microbiology Section, Department of Biological Sciences, Faculty of Science, University of Botswana, Private Bag 00704, Gaborone, Botswana
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Maximilian A.K. Magulye
- Department of Health and Biomedical Sciences, Didia Education and Health Organization, P. O. Box 113, Shinyanga, Tanzania
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Emmanuel Eilu
- Department of Microbiologgy and Immunology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Ishaka, Uganda
| | - Simon Sekyanzi
- Department of Medical Microbiology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Savannah Mwesigwa
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Eric Katagirya
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
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Zhuo C, Zheng B, Wattanakamolkul K, Nakayama Y, Cloutier M, Gauthier-Loiselle M, Feng J, Wu D, Neary MP, Geurtsen J, El Khoury AC, Gu Y. Impact of Invasive Escherichia Coli Disease on Clinical Outcomes and Medical Resource Utilization Among Asian Patients in the United States. Infect Dis Ther 2024; 13:313-328. [PMID: 38265627 PMCID: PMC10904694 DOI: 10.1007/s40121-023-00911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Invasive Escherichia coli disease (IED) can lead to sepsis and death and is associated with a substantial burden. Yet, there is scarce information on the burden of IED in Asian patients. METHODS This retrospective study used US hospital data from the PINC AI™ Healthcare database (October 2015-March 2020) to identify IED cases among patients aged ≥ 60 years. IED was defined as a positive E. coli culture in blood or other normally sterile body site (group 1 IED) or positive culture of E. coli in urine with signs of sepsis (group 2 IED). Eligible patients with IED were classified into Asian and non-Asian cohorts based on their reported race. Entropy balancing was used to create cohorts with similar characteristics. Outcomes following IED were descriptively reported in the balanced cohorts. RESULTS A total of 646 Asian and 19,127 non-Asian patients with IED were included (median age 79 years; 68% female after balancing). For both cohorts, most IED encounters had community-onset (> 95%) and required hospitalization (Asian 96%, mean duration 6.9 days; non-Asian 95%, mean duration 6.8 days), with frequent admission to intensive care (Asian 35%, mean duration 3.3 days; non-Asian 34%, mean duration 3.5 days), all standardized differences [SD] < 0.20. Compared to non-Asian patients, Asian patients were more likely to be discharged home (54% vs. 43%; SD = 0.22), and less likely to be discharged to a skilled nursing facility (24% vs. 31%; SD = 0.16). In-hospital fatality rates during the IED encounter were similar across cohorts (Asian 9%, non-Asian 10%; SD = 0.01). Most E. coli isolates showed resistance to ≥ 1 antibiotic (Asian 61%; non-Asian 64%) and 36% to ≥ 3 antibiotic classes (all SD < 0.20). CONCLUSION IED is associated with a substantial burden, including need for intensive care and considerable mortality, in Asian patients in the USA that is consistent with that observed for non-Asian patients.
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Affiliation(s)
- Chao Zhuo
- Department of Infectious Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Bo Zheng
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, People's Republic of China
| | | | | | - Martin Cloutier
- Health Economics and Outcomes Research, Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Marjolaine Gauthier-Loiselle
- Health Economics and Outcomes Research, Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada.
| | - Jun Feng
- Johnson and Johnson International (Singapore) PTE. Ltd, Singapore, Singapore
| | - David Wu
- Johnson and Johnson International (Singapore) PTE. Ltd, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Maureen P Neary
- Janssen Global Services, LLC, 1000 U.S. Route 202 South, Raritan, NJ, 08869, USA
| | - Jeroen Geurtsen
- Bacterial Vaccines Research and Early Development, Janssen Vaccines and Prevention BV, Leiden, 2333 CN, The Netherlands
| | - Antoine C El Khoury
- Janssen Global Services, LLC, 1000 U.S. Route 202 South, Raritan, NJ, 08869, USA
| | - Yoshiaki Gu
- Department of Infectious Diseases, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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