Prevalence of Virulence Genes and Clonality in Escherichia coli Strains That Cause Bacteremia in Cancer Patients

doi:10.1128/IAI.68.7.3983-3989.2000

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Infection and Immunity, July 2000, p. 3983-3989, Vol. 68, No. 7
0019-9567/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Prevalence of Virulence Genes and Clonality in Escherichia coli Strains That Cause Bacteremia in Cancer Patients

Farida Hilali,¹^,² Raymond Ruimy,¹ Patrick Saulnier,² Christian Barnabé,³ Chantal Lebouguénec,⁴ Michel Tibayrenc,³ and Antoine Andremont¹^,^*

EMI INSERM 9933, AP-HP Hôpital Bichat Claude-Bernard,¹ and Unité de Pathogénie Bactérienne des Muqueuses, Institut Pasteur,⁴ Paris, Laboratoire de Microbiologie Médicale, Institut Gustave Roussy, Villejuif,² and Centre d'Etudes sur le Polymorphisme des Microorganismes (CEPM), UMR CNRS/IRD 9926, IRD, Montpellier,³ France

Received 20 April 1999/Returned for modification 30 June 1999/Accepted 31 March 2000

Phenotypic analysis of Escherichia coli strains causing bacteremia in cancer patients suggests that they possess specificvirulence properties. To investigate this hypothesis, we comparedthe frequency of the virulence-related genes cnf1, cnf2, papC,hlyC, and iut in 155 E. coli strains isolated from hospitalizedcancer patients with epidemiologically unrelated cases of bacteremiato their frequency in 70 E. coli strains isolated from the fecesof healthy unrelated volunteers. Of the blood isolates, 24, 37,and 26% were positive for cnf1, papC, and hlyC, respectively,versus only 6, 17, and 6% of the fecal isolates (P < 0.05 in allinstances). By contrast, 47% of both isolates carried the iutgene. The patients' clinical characteristics did not significantlyinfluence these frequencies. The presence on various pathogenicityislands (PAIs) of a combination of the cnf1, papC, and hlyC geneson the chromosome was strongly suggested by Southern blottingof pulsed-field gel electrophoresis (PFGE) patterns with specificDNA probes. The phylogenetic relatedness among 60 strains carryingthree, two, one, or no virulence genes and 6 ECOR strains includedas references was determined by neighbor joining, the unweightedpair-group method with arithmetic mean, and Wagner analysis ofthe randomly amplified polymorphic DNA (RAPD) patterns generatedby 11 primers. Identification of a major cluster including 96.4%of the strains carrying the cnf1, papC, and hlyC genes and ECORsubgroup B2 strains suggested that the virulent E. coli strainscausing bacteremia in cancer patients are closely related to ECORB2 strains. The presence in the E. coli population surveyed ofa strong linkage disequilibrium, and especially of a highly significantcorrelation between PFGE and RAPD genetic distances, confirmsthat clonal propagation has a major impact on the E. coli populationstructure. Nevertheless, low bootstrap values in the phylogenetictree suggested that frequent genetic exchange inhibits the individualizationof discrete genetic lineages, which are stable on an evolutionaryscale.

^* Corresponding author. Mailing address: Laboratoire de Bactériologie, Groupe Hospitalier Bichat-Claude Bernard, 47, rue HenriHuchard, 75877 Paris Cedex 18, France. Phone: 33 (0)1 40 25 8500. Fax: 33 (0)1 40 25 85 81. E-mail: antoine.andremont{at}bch.ap-hop-paris.fr.

Infection and Immunity, July 2000, p. 3983-3989, Vol. 68, No. 7
0019-9567/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

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