Genotypic and Phenotypic Characterization of Escherichia coli Isolates From Children With Urinary Tract Infection and From Healthy Carriers

1Charles Sturt University, Leeds Parade, Orange, NSW 2800, Australia. 2Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota 55417, USA. 3Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW 2145, Australia. 4Sydney Institute for Emerging Infectious Diseases and Biosecurity, University of Sydney, NSW 2006, Australia.
The Pediatric Infectious Disease Journal (Impact Factor: 2.72). 02/2013; 32(5). DOI: 10.1097/INF.0b013e31828ba3f1
Source: PubMed


Urinary tract infections (UTI) are common in children and contribute significantly to morbidity and mortality. The major cause is Escherichia coli, carrying multiple virulence-associated factors (VFs). However, the specific traits that distinguish childhood uropathogenic E. coli from fecal commensals of healthy children are incompletely defined.

We used a multiplex polymerase chain reaction-based reverse line blot assay, several additional polymerase chain reactions and phenotypic methods to compare distributions of virulence traits (22 VF genes, UTI-associated O types, phylogenetic groups, sequence type 131 and expression of selected VFs), between 212 E. coli isolates from children ≤ 5 years with UTI (109 cystitis and 103 pyelonephritis) and 115 fecal isolates from healthy children of similar age, collected during the same time period.

The studied traits were most prevalent among pyelonephritis, followed closely by cystitis isolates and were uncommon among fecal isolates. Eight VF genes differentiated pyelonephritis from cystitis isolates, but aggregate VF scores in these 2 UTI groups were similar. Most of the studied phenotypic characteristics showed a similar descending prevalence gradient from pyelonephritis, through cystitis, to fecal isolates. Coexpression of biofilm components, curli and cellulose, was strongly associated with pyelonephritis, phylogenetic group B2, individual VF genes and higher VF scores. Two-thirds (67%) of clinical isolates belonged to phylogenetic group B2 and, of these, 12% belonged to the sequence type 131 clonal group, compared with 14% and 1%, respectively, of fecal isolates.

These findings identify specific virulence factors, O types and a virulent clonal group (sequence type 131), as potential targets for UTI prevention strategies in children.

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    • "Curli also contribute to the immune response by activating the Toll-like receptors (TLR1 and TLR2) and the CD14 complex [28] [29]. A recent study examining isolates from UTI in children found that the co-expression of curli and cellulose was most prevalent in isolates associated with severe UTI, particularly pyelonephritis [27]. In the laboratory, the coproduction of curli and cellulose enables the elaboration of bacterial biofilms formed on agar [30], characterized by the hallmark wrinkled colony morphology, as well as biofilms at the air–liquid interface (pellicle), and biofilms attached to plastic (e.g. "
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