{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:52:03Z","timestamp":1790617923331,"version":"4.1.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2020,9,15]],"date-time":"2020-09-15T00:00:00Z","timestamp":1600128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U19 AI11497"],"award-info":[{"award-number":["U19 AI11497"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Novel Alternative Model Systems of Enteric Diseases","award":["NIH P30 DK56338"],"award-info":[{"award-number":["NIH P30 DK56338"]}]},{"name":"Texas Medical Center Digestive Diseases Center","award":["NIH U19AI-144297-01"],"award-info":[{"award-number":["NIH U19AI-144297-01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The role of enteropathogenic Escherichia coli (EPEC) as a cause of diarrhea in cancer and immunocompromised patients is controversial. Quantitation of fecal bacterial loads has been proposed as a method to differentiate colonized from truly infected patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We studied 77 adult cancer and immunosuppressed patients with diarrhea and EPEC identified in stools by FilmArray, 25 patients with pathogen-negative diarrhea, and 21 healthy adults without diarrhea. Stools were studied by quantitative polymerase chain reaction (qRT-PCR) for EPEC genes eaeA and lifA\/efa-1 and strains characterized for virulence factors and adherence to human intestinal enteroids (HIEs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with EPEC were more likely to have community-acquired diarrhea (odds ratio, 3.82 [95% confidence interval, 1.5\u201310.0]; P = .008) compared with pathogen-negative cases. Although EPEC was identified in 3 of 21 (14%) healthy subjects by qPCR, the bacterial burden was low compared to patients with diarrhea (\u226455 vs median, 6 \u00d7 104 bacteria\/mg stool; P &amp;lt; .001). Among EPEC patients, the bacterial burden was higher in those who were immunosuppressed (median, 6.7 \u00d7 103 vs 55 bacteria\/mg; P &amp;lt; .001) and those with fecal lifA\/ifa-1 (median, 5 \u00d7 104 vs 120 bacteria\/mg; P = .015). Response to antimicrobial therapy was seen in 44 of 48 (92%) patients with EPEC as the sole pathogen. Antimicrobial resistance was common and strains exhibited distinct patterns of adherence with variable cytotoxicity when studied in HIEs. Cancer care was delayed in 13% of patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Immunosuppressed cancer patients with EPEC-associated diarrhea carry high burden of EPEC with strains that are resistant to antibiotics, exhibit novel patterns of adherence when studied in HIEs, and interfere with cancer care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1394","type":"journal-article","created":{"date-parts":[[2020,9,11]],"date-time":"2020-09-11T15:12:06Z","timestamp":1599837126000},"page":"e620-e629","source":"Crossref","is-referenced-by-count":19,"title":["Enteropathogenic\n                    <i>Escherichia coli<\/i>\n                    Infection in Cancer and Immunosuppressed Patients"],"prefix":"10.1093","volume":"72","author":[{"given":"Adilene","family":"Olvera","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Carter","sequence":"additional","affiliation":[{"name":"Department of Integrative Molecular and Biomedical Sciences, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anubama","family":"Rajan","sequence":"additional","affiliation":[{"name":"Department of Integrative Molecular and Biomedical Sciences, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily G","family":"Carlin","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomin","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi-Lei","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Shelburne","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micah","family":"Bhatti","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E","family":"Blutt","sequence":"additional","affiliation":[{"name":"Department of Integrative Molecular and Biomedical Sciences, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah F","family":"Shroyer","sequence":"additional","affiliation":[{"name":"Department of Integrative Molecular and Biomedical Sciences, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Jenq","sequence":"additional","affiliation":[{"name":"Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary K","family":"Estes","sequence":"additional","affiliation":[{"name":"Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Maresso","sequence":"additional","affiliation":[{"name":"Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1596-3411","authenticated-orcid":false,"given":"Pablo C","family":"Okhuysen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, USA"},{"name":"Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,9,15]]},"reference":[{"key":"2021051810400802100_CIT0001","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/S0140-6736(13)60844-2","article-title":"Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control 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