Emergence of Enteroaggregative Escherichia coli within the ST131 Lineage as a Cause of Extraintestinal Infections
Erik J. Boll, Søren Overballe‐Petersen, Henrik Hasman, Louise Roer, Kim Lee Ng, Flemming Scheutz, Anette M. Hammerum, Arnold Matovu Dungu, Frank Hansen, Thor Bech Johannesen, Abigail J. Johnson, Divek V. T. Nair, Berit Lilje, Dennis Schrøder Hansen, Karen A. Krogfelt, Timothy J. Johnson, Lance B. Price, James R. Johnson, Carsten Struve, Bente Olesen, Marc Stegger
Abstract
E. coli ST131 is an important extraintestinal pathogenic lineage. A signature characteristic of ST131 is its ability to asymptomatically colonize the gastrointestinal tract and then opportunistically cause extraintestinal infections, such as cystitis, pyelonephritis, and urosepsis. In this study, we identified an ST131 H 27 sublineage that has acquired the enteroaggregative diarrheagenic phenotype, spread across multiple continents, and caused multiple outbreaks of community-acquired ESBL-associated bloodstream infections in Denmark. The strain’s ability to both cause diarrhea and innocuously colonize the human gastrointestinal tract may facilitate its dissemination and establishment in the community.