{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:14:01Z","timestamp":1790727241483,"version":"4.1.0"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T00:00:00Z","timestamp":1722211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K08 AI171183"],"award-info":[{"award-number":["K08 AI171183"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01 AI165671"],"award-info":[{"award-number":["R01 AI165671"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","award":["U19AI110819"],"award-info":[{"award-number":["U19AI110819"]}],"id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U54CK000603"],"award-info":[{"award-number":["U54CK000603"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The innate immune system eliminates bloodstream pathogens such as <jats:italic>Escherichia coli<\/jats:italic> in part through complement protein deposition and subsequent bacterial death (i.e., \u201cserum killing\u201d). Some <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> strains have developed mechanisms to resist serum killing, though the extent of variation in serum killing among bloodstream infection (BSI) isolates and the clinical impact of this variation is not well understood. To address this issue, we developed a novel assay that uses flow cytometry to perform high throughput serum bactericidal assays (SBAs) with <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> BSI isolates (n = 183) to define the proportion of surviving bacteria after exposure to serum. We further determined whether <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> resistance to serum killing is associated with clinical outcomes (e.g., in-hospital attributable mortality, in-hospital total mortality, septic shock) and bacterial genotype in the corresponding patients with <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> BSI. Our novel flow cytometry-based SBA performed similarly to a traditional SBA, though with significantly decreased hands-on bench work. Among <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> BSI isolates, the mean proportion that survived exposure to 25% serum was 0.68 (Standard deviation 0.02, range 0.57\u20130.93). We did not identify associations between <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> resistance to serum killing and clinical outcomes in our adjusted models. Together, this study describes a novel flow cytometry-based approach to the bacterial SBA that allowed for high-throughput testing of <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> BSI isolates and identified high variability in resistance to serum killing among a large set of BSI isolates.<\/jats:p>","DOI":"10.1371\/journal.pone.0307968","type":"journal-article","created":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T19:25:29Z","timestamp":1722281129000},"page":"e0307968","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Serum susceptibility of Escherichia coli and its association with patient clinical outcomes"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3599-3439","authenticated-orcid":true,"given":"Orianna","family":"Poteete","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Cox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia","family":"Ruffin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Granger","family":"Sutton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Brinkac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas H.","family":"Clarke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derrick E.","family":"Fouts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vance G.","family":"Fowler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3250-0697","authenticated-orcid":true,"given":"Joshua T.","family":"Thaden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,7,29]]},"reference":[{"issue":"4","key":"pone.0307968.ref001","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1128\/CMR.00022-13","article-title":"Recent advances in understanding enteric pathogenic Escherichia coli","volume":"26","author":"MA Croxen","year":"2013","journal-title":"Clin Microbiol Rev"},{"issue":"3","key":"pone.0307968.ref002","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1111\/jam.13468","article-title":"Environmental Escherichia coli: ecology and public health implications-a review","volume":"123","author":"J Jang","year":"2017","journal-title":"J Appl Microbiol"},{"key":"pone.0307968.ref003","first-page":"34","author":"CL Holmes","year":"2021","journal-title":"Pathogenesis of Gram-Negative Bacteremia. 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