Prevalence of Antibiotic Tolerance and Risk for Reinfection Among Escherichia coli Bloodstream Isolates: A Prospective Cohort Study. (22nd April 2022)

• Record Type: Journal Article
• Authors: Lazarovits, Gilad; Gefen, Orit; Cahanian, Noga; Adler, Karen; Fluss, Ronen; Levin-Reisman, Irit; Ronin, Irine; Motro, Yair; Moran-Gilad, Jacob; Balaban, Nathalie Q; Strahilevitz, Jacob
• Is Part Of: Clinical infectious diseases. Volume 75:Number 10(2022)
• Page Start: 1706
• Page End: 1713
• Publication Date: 2022-04-22
• Subjects: antimicrobials -- bloodstream infection -- tolerance; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciac281
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Tolerance is the ability of bacteria to survive transient exposure to high concentrations of a bactericidal antibiotic without a change in the minimal inhibitory concentration, thereby limiting the efficacy of antimicrobials. The study sought to determine the prevalence of tolerance in a prospective cohort of E. coli bloodstream infection and to explore the association of tolerance with reinfection risk. Methods: Tolerance, determined by the Tolerance Disk Test (TDtest), was tested in a prospective cohort of consecutive patient-unique E. coli bloodstream isolates and a collection of strains from patients who had recurrent blood cultures with E. coli (cohorts 1 and 2, respectively). Selected isolates were further analyzed using time-dependent killing and typed using whole-genome sequencing. Covariate data were retrieved from electronic medical records. The association between tolerance and reinfection was assessed by the Cox proportional-hazards regression and a Poisson regression models. Results: In cohort 1, 8/94 isolates (8.5%) were tolerant. Using multivariate analysis, it was determined that the risk for reinfection in the patients with tolerant index bacteremia was significantly higher than for patients with a nontolerant strain, hazard ratio, 3.98 (95% confidence interval, 1.32–12.01). The prevalence of tolerance among cohort 2 was higher than in cohort 1, 6/21(28.6%) vs 8/94 (8.5%), respectively ( P = .02). Conclusions: Tolerant E. coli are frequently encountered among bloodstream isolates and are associated with an increased risk of reinfection. The TDtest appears to be a practicable approach for tolerance detection and could improve future patient management. Abstract : Tolerance may lead to the failure of antibiotic therapy. Applying the Tolerance Disk Test, we found that 8.5% of Escherichia coli bloodstream infections were tolerant, tolerant strains were more frequent among patients with recurrent bacteremia, and tolerance was an independent risk for reinfection.