{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T08:47:01Z","timestamp":1789980421515,"version":"4.0.1"},"reference-count":246,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,1,15]]},"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Observational studies have suggested that\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      sequence type (ST) 131 and\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      ST258 have hyperendemic properties. This would be obvious from continuously high incidence and\/or prevalence of carriage or infection with these bacteria in specific patient populations. Hyperendemicity could result from increased transmissibility, longer duration of infectiousness, and\/or higher pathogenic potential as compared with other lineages of the same species. The aim of our research is to quantitatively estimate these critical parameters for\n                      <jats:italic>E. coli<\/jats:italic>\n                      ST131 and\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      ST258, in order to investigate whether\n                      <jats:italic>E. coli<\/jats:italic>\n                      ST131 and\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      ST258 are truly hyperendemic clones.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>\n                      A systematic literature search was performed to assess the evidence of transmissibility, duration of infectiousness, and pathogenicity for\n                      <jats:italic>E. coli<\/jats:italic>\n                      ST131 and\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      ST258. Meta-regression was performed to quantify these characteristics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The systematic literature search yielded 639 articles, of which 19 data sources provided information on transmissibility (\n                      <jats:italic>E. coli<\/jats:italic>\n                      ST131 n=9;\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      ST258 n=10)), 2 on duration of infectiousness (\n                      <jats:italic>E. coli<\/jats:italic>\n                      ST131 n=2), and 324 on pathogenicity (\n                      <jats:italic>E. coli<\/jats:italic>\n                      ST131 n=285;\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      ST258 n=39). Available data on duration of carriage and on transmissibility were insufficient for quantitative assessment. In multivariable meta-regression\n                      <jats:italic>E. coli<\/jats:italic>\n                      isolates causing infection were associated with ST131, compared to isolates only causing colonisation, suggesting that\n                      <jats:italic>E. coli<\/jats:italic>\n                      ST131 can be considered more pathogenic than non-ST131 isolates. Date of isolation, location and resistance mechanism also influenced the prevalence of ST131.\n                      <jats:italic>E. coli<\/jats:italic>\n                      ST131 was 3.2 (95% CI 2.0 to 5.0) times more pathogenic than non-ST131. For\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      ST258 there were not enough data for meta-regression assessing the influence of colonisation versus infection on ST258 prevalence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      With the currently available data, it cannot be confirmed nor rejected, that\n                      <jats:italic>E. coli<\/jats:italic>\n                      ST131 or\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      ST258 are hyperendemic clones.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2015-009971","type":"journal-article","created":{"date-parts":[[2016,3,17]],"date-time":"2016-03-17T22:51:26Z","timestamp":1458255086000},"page":"e009971","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":48,"title":["Epidemic potential of\n                    <i>Escherichia coli<\/i>\n                    ST131 and\n                    <i>Klebsiella pneumoniae<\/i>\n                    ST258: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"6","author":[{"given":"M J D","family":"Dautzenberg","sequence":"first","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands"},{"name":"Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M 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