Clinical and Bacteriological Specificities of Escherichia coli Bloodstream Infections From Biliary Portal of Entries
Authors: Sokal Aurélien , Royer Guilhem , Esposito-Farese Marina , Clermont Olivier , Condamine Bénédicte , Laouénan Cedric , Lefort Agnès , Denamur Erick , de Lastours Victoire ,   for the Colibafi Septicoli and Coliville Groups, Wolff Michel , Alavoine Loubna , Duval Xavier , Skurnik David , Woerther Paul-Louis , Andremont Antoine , Carbonnelle Etienne , Lortholary Olivier , Nassif Xavier , Abgrall Sophie , Jaureguy Françoise , Picard Bertrand , Houdouin Véronique , Aujard Yannick , Bonacorsi Stéphane , Meybeck Agnès , Barnaud Guilène , Branger Catherine , Lefort Agnès , Fantin Bruno , Bellier Claire , Bert Frédéric , Nicolas-Chanoine Marie-Hélène , Page Bernard , Cremniter Julie , Gaillard Jean-Louis , Leturdu Françoise , Sollet Jean-Pierre , Plantefève Gaëtan , Panhard Xavière , Mentré France , Marcault Estelle , Tubach Florence , Zarrouk Virginie , Duprilot Marion , Leflon-Guibout Véronique , Maataoui Naouale , Armand Laurence , Nguyen Liem Luong , Collarino Rocco , Munier Anne-Lise , Jacquier Hervé , Lecorché Emmanuel , Coutte Laetitia , Gomart Camille , Fateh Ousser Ahmed , Landraud Luce , Messika Jonathan , Aslangul Elisabeth , Gerin Magdalena , Bleibtreu Alexandre , Lescat Mathilde , Walewski Violaine , Mechaï Frederic , Dollat Marion , Maherault Anne-Claire , Mercier-Darty Mélanie , Basse Bernadette , Fantin Bruno , Duval Xavier , Carbonnelle Etienne , Decousser Jean-Winoc , Lepeule Raphaël , Allouche Monique , Aubert Jean-Pierre , Aubin Isabelle , Audran Ghislaine , Baruch Dan , Birembaux Philippe , Budowski Max , Chemla Emilie , Eddi Alain , Frarier Marc , Galam Eric , Gelly Julien , Joly Serge , Millet Jean-François , Nougairede Michel , Pillon Nadja , Septavaux Guy , Szwebel Catherine , Vellard Philippe , Wakim Raymond , Watelet Xavier , Zerr Philippe 
Published: January 2024

Abstract

Background
Escherichia coli is frequently responsible for bloodstream infections (BSIs). Among digestive BSIs, biliary infections appear to be less severe. Respective roles of host factors, bacterial determinants (phylogroups, virulence, and antibiotic resistance), and portal of entry on outcome are unknown.

Methods
Clinical characteristics and prognosis of 770 episodes of E coli BSI were analyzed and isolates sequenced (Illumina technology) comparing phylogroups, multilocus sequence type, virulence, and resistance gene content. BSI isolates were compared with 362 commensal E coli from healthy subjects.

Results
Among 770 episodes, 135 were biliary, 156 nonbiliary digestive, and 479 urinary. Compared to urinary infections, BSIs of digestive origin occurred significantly more in men, comorbid, and immunocompromised patients. Digestive portal of entry was significantly associated with septic shock and death. Among digestive infections, patients with biliary infections were less likely to die (P = .032), despite comparable initial severity. Biliary E coli resembled commensals (phylogroup distribution, sequence type, and few virulence-associated genes) whereas nonbiliary digestive and urinary strains carried many virulence-associated genes.

Conclusions
Escherichia coli strains responsible for biliary infections exhibit commensal characteristics and are associated with lower mortality rates, despite similar initial severity, than other digestive BSIs. Biliary drainage in addition to antibiotics in the management of biliary infections may explain improved outcome.