Enteropathogenic Escherichia coli Infection in Cancer and Immunosuppressed Patients.

TitleEnteropathogenic Escherichia coli Infection in Cancer and Immunosuppressed Patients.
Publication TypeJournal Article
Year of Publication2021
AuthorsOlvera, A, Carter, H, Rajan, A, Carlin, LG, Yu, X, Zeng, X-L, Shelburne, S, Bhatti, M, Blutt, SE, Shroyer, NF, Jenq, R, Estes, MK, Maresso, A, Okhuysen, PC
JournalClin Infect Dis
Date Published2021 May 18
KeywordsAdult, Diarrhea, Enteropathogenic Escherichia coli, Escherichia coli Infections, Feces, Humans, Immunocompromised Host, Neoplasms

BACKGROUND: The role of enteropathogenic Escherichia coli (EPEC) as a cause of diarrhea in cancer and immunocompromised patients is controversial. Quantitation of fecal bacterial loads has been proposed as a method to differentiate colonized from truly infected patients.METHODS: We studied 77 adult cancer and immunosuppressed patients with diarrhea and EPEC identified in stools by FilmArray, 25 patients with pathogen-negative diarrhea, and 21 healthy adults without diarrhea. Stools were studied by quantitative polymerase chain reaction (qRT-PCR) for EPEC genes eaeA and lifA/efa-1 and strains characterized for virulence factors and adherence to human intestinal enteroids (HIEs).RESULTS: Patients with EPEC were more likely to have community-acquired diarrhea (odds ratio, 3.82 [95% confidence interval, 1.5-10.0]; P = .008) compared with pathogen-negative cases. Although EPEC was identified in 3 of 21 (14%) healthy subjects by qPCR, the bacterial burden was low compared to patients with diarrhea (≤55 vs median, 6 × 104 bacteria/mg stool; P < .001). Among EPEC patients, the bacterial burden was higher in those who were immunosuppressed (median, 6.7 × 103 vs 55 bacteria/mg; P < .001) and those with fecal lifA/ifa-1 (median, 5 × 104 vs 120 bacteria/mg; P = .015). Response to antimicrobial therapy was seen in 44 of 48 (92%) patients with EPEC as the sole pathogen. Antimicrobial resistance was common and strains exhibited distinct patterns of adherence with variable cytotoxicity when studied in HIEs. Cancer care was delayed in 13% of patients.CONCLUSIONS: Immunosuppressed cancer patients with EPEC-associated diarrhea carry high burden of EPEC with strains that are resistant to antibiotics, exhibit novel patterns of adherence when studied in HIEs, and interfere with cancer care.

Alternate JournalClin Infect Dis
PubMed ID32930708
PubMed Central IDPMC8130029
Grant ListP30 DK056338 / DK / NIDDK NIH HHS / United States
R01 DK118904 / DK / NIDDK NIH HHS / United States
U19 AI116497 / AI / NIAID NIH HHS / United States
U19 AI144297 / AI / NIAID NIH HHS / United States