Basic reproduction number for pandemic Escherichia coli clones is comparable to typical pandemic viruses

Abstract

Extra-intestinal pathogenic Escherichia coli (ExPEC) ubiquitously colonize the human gut and represent clinically the most significant bacterial species causing urinary tract infections and bacteremia in addition to contributing to meningitis in neonates. During the last two decades, new E. coli multi-drug resistant clones such as ST131, particularly its clades C1 and C2, have spread globally, as has their generally less resistant sister clade ST131-A. Phylodynamic coalescent modeling has indicated exponential growth in the populations corresponding to these clades during the early 2000s. However, it remains unknown how their transmission dynamics compare to viral epidemics and pandemics in terms of key epidemiological quantities such as the basic reproduction number (R0). Estimation of R0 for opportunistic pathogenic bacteria poses a difficult challenge compared to viruses causing acute infections, since data on E. coli infections accumulate with a much longer delay, even in the most advanced public health reporting systems. Here, we developed a compartmental model for asymptomatic gut colonization and onward transmission coupled with a stochastic epidemiological observation model for bacteremia and fitted the model to annual Norwegian national E. coli disease surveillance and bacterial population genomics data. Approximate Bayesian Computation leveraged by the ELFI software package was used to infer R0 for the pandemic ST131 clades. The resulting R0 estimates for ST131-A, ST131-C1 and ST131-C2 were 1.47 (1.31-1.60), 1.18 (1.12-1.20) and 1.13 (1.08-1.20), respectively, indicating that the ST131-A transmission potential can be even comparable to pandemic influenza viruses, such as H1N1. The significantly lower transmissibility of ST131-C1 and ST131-C2 suggests that their global dissemination has been aided by antibiotic selection pressure and that they may be more effectively transmitted through healthcare facilities instead of primarily community-driven transmission. In summary our results provide a fundamental advance in understanding the relative transmissibility of these opportunistic pathogens and that it can vary markedly even between very closely related E. coli.