Studies on the Epidemiology of Escherichia coli Infections. V. Factors Influencing Acquisition of Specific Serologic Groups*

Abstract

Summary. Stool carrier rates of Escherichia coli serogroups 4, 6, and 75 were determined on admission and discharge for 190 patients. Persons who were in the hospital 3 weeks or longer had an intestinal carrier rate of 46% compared to a rate of 28% in individuals who had no recent hospital contact. Treatment with broad spectrum antibiotics increased the susceptibility for acquisition of certain specific serologic groups. This was apparently not related to replacement of sensitive E. coli by drug-resistant forms. Studies were made to determine the environmental source for colonization of hospitalized patients and the risk of urinary infection in stool carriers of these strains. A survey of inanimate objects of medical and urological wards demonstrated infrequent isolation of 04, 06, and 075, indicating that extraintestinal foci were an unlikely source for hospital-acquired E. coli. Hemagglutination titers with determination of group-specific 0 antibody failed to demonstrate any deficiency in hospitalized patients who became colonized with certain coliforms. Similarly, no significant deficit in group-specific serum antibody was found in patients who were community carriers of E. coli 04, 06, or 075. Despite a high rate of acquisition of E. coli serogroups 4, 6, and 75 in the stools of hospitalized patients, only those patients undergoing urinary tract manipulation developed bacteriuria.

Bacteriophage Typing as an Epidemiological Tool for Urinary Escherichia coli1

“…We found no correlation between the phage type and the pattern of resistance to antibiotics. Although the routine use of antibiotics in therapy may possibly have been responsible for the predominance of strains found resistant to tetracycline and dihydrostreptomycin in our study, Winterbauer, Turck, and Petersdorf reported (14) that treatment with broad-spectrum antibiotics did not result in the replacement of sensitive strains of E. coli by resistant strains. On the contrary, these investigators reported that antibiotic therapy increased the fecal carrier rate of certain serological groups which frequently cause urinary tract infections.…”

Terminal bronchopneumonia. A bacteriological and histological study of 111 necropsies

“…Since the strains isolated in this survey showed no increase in antibiotic resistance, we have no evidence of it, although Winterbauer et al (1967) found that patients receiving broad-spectrum antibiotics had a tendency to acquire E. coli of 0 groups 4, 6 and 75 and felt that this was the result of alteration of the intestinal flora by antibiotics.…”

“…Much of this work has concentrated on urinary infection but our investigation suggests that in terminal bronchopneumonia there may be a high proportion of infections by certain serotypes (06, 075 and 018). Kennedy et al (1965) and Winterbauer, Turck & Petersdorf (1967) found that types 04, 06 and 075 occur more frequently in the faeces of patients and staff in hospital and the carrier rate among patients was directly related to the time spent in hospital; inanimate objects in the wards were rarely contaminated and they therefore suggested that antibiotic treatment or other factors present in hospital patients might encourage spread from the endogenous bowel flora. Since, however, 40 % of the hospital staff in their study were carrying these serotypes there would seem to have been ample opportunity for transmission by direct personal contact.…”