Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
University of Minnesota, Minneapolis, Minnesota, USA.
J Infect Dis. 2022 Jun 15;225(12):2197-2207. doi: 10.1093/infdis/jiab638.
Superior gut colonization may underlie the pandemic emergence of the resistance-associated H30 subclone of Escherichia coli sequence type 131 (ST131-H30). Little is known about the associated host and bacterial characteristics, or the comparative persistence of non-ST131 intestinal E. coli.
Generic and fluoroquinolone-resistant E. coli isolates from volunteers' serial fecal samples underwent clonal analysis and extensive polymerase chain reaction (PCR)-based characterization (phylogroup, selected sequence types, virulence genes). Kaplan-Meier survival analysis and Cox proportional hazards survival analysis using penalized regression (a machine-learning method) were used to identify correlates of strain persistence.
Screening of 2005 subjects at the Minneapolis VA Medical Center identified 222 subjects (117 veterans, 105 human and animal household members) for longitudinal fecal surveillance. Analysis of their 585 unique-by-subject fecal E. coli strains identified multiple epidemiological, ecological, and bacterial correlates of strain persistence. ST131-H30, a strong univariable correlate of persistence, was superseded in multivariable analysis by outpatient status, fluoroquinolone resistance, and diverse (predominantly iron uptake-related) virulence genes.
ST131-H30 exhibits exceptional intestinal persistence, possibly due to a combination of fluoroquinolone resistance and virulence factors, which may be primarily colonization factors. This identifies both likely contributors to the ST131-H30 pandemic and potential targets for interventions against it.
超级肠道定植可能是大肠杆菌 131 型序列类型 131（ST131-H30）耐药相关 H30 亚克隆流行的基础。人们对相关宿主和细菌特征以及非 ST131 肠道大肠杆菌的比较持久性知之甚少。
志愿者连续粪便样本中的通用和氟喹诺酮耐药大肠杆菌分离株进行了克隆分析和广泛的聚合酶链反应（PCR）基于特征分析（进化群、选定的序列类型、毒力基因）。使用惩罚回归（一种机器学习方法）进行 Kaplan-Meier 生存分析和 Cox 比例风险生存分析，以确定菌株持续存在的相关因素。
在明尼苏达州退伍军人事务医疗中心对 2005 名受试者进行筛选，确定了 222 名受试者（117 名退伍军人，105 名人类和动物家庭成员）进行纵向粪便监测。对他们 585 个独特的个体粪便大肠杆菌菌株的分析确定了多个流行病学、生态学和细菌与菌株持续存在的相关因素。ST131-H30 是持续存在的强单变量相关因素，在多变量分析中被门诊状态、氟喹诺酮耐药性和多样化（主要与铁摄取相关）毒力基因所取代。
ST131-H30 表现出异常的肠道持久性，这可能是由于氟喹诺酮耐药性和毒力因子的结合，这些因子可能主要是定植因子。这确定了 ST131-H30 大流行的可能贡献者和针对其的干预措施的潜在目标。
