Transmission of an extended-spectrum-beta-lactamase-producing Escherichia coli (sequence type ST131) strain between a father and daughter resulting in septic shock and Emphysematous pyelonephritis

Abstract

Probable transmission of an extended-spectrum-beta-lactamase-producing Escherichia coli strain (sequence type ST131) between a father and daughter was documented. The father developed severe, recurrent pyelonephritis with multiple small abscesses; the daughter later developed septic shock, bacteremia, and extensive emphysematous pyelonephritis. This multidrug-resistant E. coli clone appears to be highly pathogenic and transmissible.

FIG. 1.

Computed tomograms (CTs) and PFGE profiles in two cases of severe pyelonephritis caused by the same E. coli strain. (Top left) Father's abdominal CT from the second hospital admission. The kidneys demonstrate patchy enhancement bilaterally, suggesting acute pyelonephritis. Both kidneys also contain several hypoattenuating foci, some of which appear to demonstrate peripheral rim enhancement, consistent with small intrarenal abscesses (arrows). (Top right and middle left) Daughter's predrainage abdominal CT. The left kidney contains air-fluid levels and mottled gas collections (arrows), compatible with emphysematous pyelonephritis. The right kidney is enlarged and somewhat inhomogeneous in attenuation, suggesting acute pyelonephritis. (Middle right) Daughter's postdrainage abdominal CT, showing a left-sided drainage catheter and resolution of the large intrarenal fluid/gas collection. (Bottom) PFGE profiles of three clinical E. coli isolates from the case patients, plus the index strain for (ST131-associated) PFGE type 841. All isolates exhibit >95% similar profiles (according to Dice coefficients).