Clinical and molecular correlates of virulence in Escherichia coli causing bloodstream infection following transrectal ultrasound-guided (TRUS) prostate biopsy

Objectives: Prevention and management of Escherichia coli bacteraemia following transrectal ultrasound-guided (TRUS) prostate biopsy has become increasingly complicated by antimicrobial resistance, particularly to fluoroquinolones. Moreover, the globally disseminated, multiresistant sequence type 131 (ST131) E. coli clonal group has recently been described as a major pathogen in the setting of post-biopsy sepsis. Accordingly, we sought to further explore the clinical and molecular epidemiology of post-TRUS biopsy E. coli bacteraemia by comparing the phylogenetic, resistance and virulence characteristics of post-TRUS biopsy E. coli bloodstream isolates with E. coli bloodstream isolates from male patients with spontaneous urosepsis. Methods: Multiplex PCR was used to compare the phylogenetic group and virulence-associated genes between post-biopsy E. coli isolates and E. coli bloodstream isolates from males with spontaneous urosepsis. Antimicrobial resistance profiles were also compared between the two groups. In addition, we compared the clinical characteristics and outcomes of post-TRUS biopsy patients with E. coli ST131 versus non-ST131 bacteraemia. Results: Although post-TRUS biopsy E. coli isolatesweremore extensively antimicrobial resistant than isolates from males with spontaneous urosepsis, they harboured significantly fewer virulence-associated genes. In addition, ST131 isolateswere significantly less virulent in nature than other isolates fromphylogenetic group B2. Clinical outcomes did not differ between patients with post-biopsy ST131 versus non-ST131 bacteraemia. Conclusions: Our data provide new insights into the molecular pathogenesis of post-TRUS biopsy E. coli bacteraemia, and suggest that antimicrobial resistance, rather than virulence genotype, is the most important bacterial trait associated with an increased risk of infection following TRUS biopsy.