Escherichia coli bacteraemia in pregnant women is life-threatening for foetuses

Surgers, Laure; Bleibtreu, Alexandre; Burdet, Charles; Clermont, Olivier; Laouénan, Cédric; Lefort, A.; Mentré, France; Carbonne, Bruno; Bingen, Édouard; Meynard, J.-L.; Denamur, Erick

doi:10.1111/1469-0691.12742

Cited by 29 publications

(27 citation statements)

References 31 publications

(57 reference statements)

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“…6,7 Trading of MDR GNB and their resistance determinants between healthcare facilities and community is adding further complexity to this puzzling landscape. 8,9 …”

Section: Introductionmentioning

confidence: 99%

The Increasing Challenge of Multidrug-Resistant Gram-Negative Bacilli

et al. 2016

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Colonization and infection by multidrug-resistant gram-negative bacilli (MDR GNB) in neonatal intensive care units (NICUs) are increasingly reported.We conducted a 5-year prospective cohort surveillance study in a tertiary NICU of the hospital “Paolo Giaccone,” Palermo, Italy. Our objectives were to describe incidence and trends of MDR GNB colonization and the characteristics of the most prevalent organisms and to identify the risk factors for colonization. Demographic, clinical, and microbiological data were prospectively collected. Active surveillance cultures (ASCs) were obtained weekly. Clusters of colonization by extended spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae were analyzed by conventional and molecular epidemiological tools.During the study period, 1152 infants were enrolled in the study. Prevalences of colonization by MDR GNB, ESBL-producing GNB and multiple species/genera averaged, respectively, 28.8%, 11.7%, and 3.7%. Prevalence and incidence density of colonization by MDR GNB and ESBL-producing GNB showed an upward trend through the surveillance period. Rates of ESBL-producing E coli and K pneumoniae colonization showed wide fluctuations peaking over the last 2 years. The only independent variables associated with colonization by MDR GNB and ESBL-producing organisms and multiple colonization were, respectively, the days of NICU stay (odds ratio [OR] 1.041), the days of exposure to ampicillin–sulbactam (OR 1.040), and the days of formula feeding (OR 1.031). Most clusters of E coli and K pneumoniae colonization were associated with different lineages. Ten out of 12 clusters had an outborn infant as their index case.Our study confirms that MDR GNB are an increasing challenge to NICUs. The universal once-a-week approach allowed us to understand the epidemiology of MDR GNB, to timely detect new clones and institute contact precautions, and to assess risk factors. Collection of these data can be an important tool to optimize antimicrobials use and control the emergence and dissemination of resistances in NICU.

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“…6,7 Trading of MDR GNB and their resistance determinants between healthcare facilities and community is adding further complexity to this puzzling landscape. 8,9 …”

Section: Introductionmentioning

confidence: 99%

The Increasing Challenge of Multidrug-Resistant Gram-Negative Bacilli

et al. 2016

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“…44 In a small study focused specifically on E. coli bacteremia during pregnancy, the same researchers determined that the rate of fetal death was 27% overall, despite adequate antibiotic therapy. 45 How can deaths from sepsis be prevented?…”

Section: Cmentioning

confidence: 99%

SMFM Consult Series #47: Sepsis during pregnancy and the puerperium

Plante

Pacheco

Louis

2019

American Journal of Obstetrics and Gynecology

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“…Other research has in fact shown that host factors and portal of entry likely outweigh bacterial determinants in predicting the severity of E. coli bacteremia 8,24. In another study of E. coli bacteremia among pregnant women, lower virulence scores were actually associated with more severe episodes 28. The link between these groups of VF and mortality will need to be addressed in larger studies.…”

Section: Discussionmentioning

confidence: 93%

Molecular epidemiology of ESBL-producing <em>E. coli</em> and <em>K. pneumoniae</em>: establishing virulence clusters

Surgers¹,

Boersma²,

Girard³

et al. 2018

IDR

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ObjectiveTo genetically characterize clusters of virulence factors (VFs) among extended spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae and assess whether these clusters are associated with genetic determinants or clinical outcomes.MethodsOne hundred forty-eight E. coli and 82 K. pneumoniae clinical isolates were obtained from 213 patients in Paris, France. Isolates underwent ESBL characterization, MultiLocus Sequence Typing (MLST) typing and phylogenetic group identification. Detection of ten E. coli and seven K. pneumoniae VF-encoding genes were assessed, from which a k-medians partition algorithm with Jaccard similarity measure was used to construct clusters.ResultsCTX-M was the predominant ESBL and susceptibility to trimethoprim–sulfamethoxazole (32%), ciprofloxacin (22%) and aminoglycosides (32%) was low. In E. coli, there were five identified clusters, with significantly different distributions of ESBL-sequence type (P<0.001), ST131 (P<0.001) and phylogenetic group (P=0.001) between clusters. “Siderophore exclusive”, “siderophore exclusive with iroN ” and “adhesin sfa/papGIII-rich” clusters had higher 12-month mortality rates compared to others (49% vs 22%, respectively, P=0.02). In K. pneumoniae, three different clusters, with significantly different distributions of aminoglycoside-sensitivity (P<0.004), MLST-type (P<0.001) and relaxase plasmids (P=0.001) were described.ConclusionDistinct clusters of E. coli and K. pneumoniae VFs are observed within ESBL-producing isolates and are strongly associated with several genetic determinants. Their association with overall morbidity and mortality requires further evidence.

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Escherichia coli bacteraemia in pregnant women is life-threatening for foetuses

Cited by 29 publications

References 31 publications

The Increasing Challenge of Multidrug-Resistant Gram-Negative Bacilli

The Increasing Challenge of Multidrug-Resistant Gram-Negative Bacilli

SMFM Consult Series #47: Sepsis during pregnancy and the puerperium

Molecular epidemiology of ESBL-producing <em>E. coli</em> and <em>K. pneumoniae</em>: establishing virulence clusters

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