Clinical features and molecular epidemiology of diarrheagenic Escherichia coli pathotypes identified by fecal gastrointestinal multiplex nucleic acid amplification in patients with cancer and diarrhea

Andrew W. Chao, Micah Bhatti, Herbert L. DuPont, James P. Nataro, Lily G. Carlin, Pablo C. Okhuysen

Research output: Contribution to journalArticle

6 Scopus citations


Diarrheagenic Escherichia coli (DEC) pathotypes with differing epidemiology and clinical features, are known causes of disease with worldwide occurrence. At a major cancer center in the U.S., we studied patients with cancer and diarrhea for whom a GI Biofire FilmArray multiplex GI panel (BFM) was performed. An enteropathogen was identified in 382 of 2017 (19%) samples distributed across 311 patients. Of these, 60/311(19%) were positive for DEC. Patients receiving hematopoietic stem cell transplants (HSCT) 29/60 (48%) or with a hematologic malignancy 17/60 (28%) accounted for the majority of DEC cases. Enteropathogenic E. coli (EPEC, n = 35 [58%]), enteroaggregative E. coli (EAEC, n = 10 [17%]) and Shiga toxin producing E. coli (STEC, n = 3 [5%]) were the most common DEC identified and peaked in the summer months. Stool cultures confirmed infections in 6/10 (60%) EAEC (five typical AggR+), and EPEC was recovered in 8/35 (22%) samples (all atypical eaeA+, bfp). DEC was identified in 22 cases (37%) that developed diarrhea >48 hours after admission suggesting health care acquisition. Chronic infections were found in 2 EPEC and 1 EAEC cases that were tested at 1 month or beyond with shedding that ranged from 58 to >125 days. Two patients that underwent hematopoietic stem cell transplantation carried EAEC strains resistant to multiple antibiotics including fluoroquinolones and expressed extended spectrum beta lactamases. While in some instances BFM results were not verified in culture and could represent false positives, DEC pathotypes, especially EPEC and EAEC, caused chronic infections with antimicrobial-resistant strains in a subset of immunosuppressed cancer patients.

Original languageEnglish (US)
Pages (from-to)235-240
Number of pages6
JournalDiagnostic Microbiology and Infectious Disease
Issue number3
Publication statusPublished - Nov 1 2017
Externally publishedYes



  • Biofire FilmArray
  • Cancer
  • Diarrhea
  • Diarrheagenic E. coli
  • Enteroaggregative E. coli
  • Enteropathogenic E. coli
  • Gastrointestinal pathogens

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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