Transmission dynamics of Escherichia coli sequence type 131 in households—a one health prospective cohort study

Rebecca Lynn Perez, Hao Chung The, Kithalakshmi Vignesvaran, Wei Cong Tan, Melissa Sin Hui Chua, En Ying Tan, Si Yu Peng, Lingyue Zhou, Shweta Rajkumar Singh, Wesley Yeung, Ivan Seah, Jeanette Teo, Kyaw Thu Aung, Cheng Yee Tang, Rick Twee-Hee Ong, Ben S. Cooper, Ritu Banerjee, Paul Anantharajah Tambyah and Yin Mo ()
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Rebecca Lynn Perez: National University of Singapore
Hao Chung The: National University of Singapore
Kithalakshmi Vignesvaran: National University Hospital
Wei Cong Tan: National University Hospital
Melissa Sin Hui Chua: National University Hospital
En Ying Tan: National University Hospital
Si Yu Peng: National University Hospital
Lingyue Zhou: National University Hospital
Shweta Rajkumar Singh: National University of Singapore
Wesley Yeung: National University Hospital
Ivan Seah: National University Hospital
Jeanette Teo: National University Hospital
Kyaw Thu Aung: National Environment Agency
Cheng Yee Tang: National University of Singapore
Rick Twee-Hee Ong: National University of Singapore
Ben S. Cooper: University of Oxford
Ritu Banerjee: Vanderbilt University
Paul Anantharajah Tambyah: National University Hospital
Yin Mo: National University of Singapore

Nature Communications, 2025, vol. 16, issue 1, 1-10

Abstract: Abstract Escherichia coli sequence type 131 (ST131) is a major cause of community-onset, multidrug-resistant extraintestinal infections. The transmission and carriage dynamics associated with E. coli ST131’s global prevalence remain poorly understood. Here, we identify a group of persistent, high-density carriers of E. coli ST131 in the community. In this prospective cohort study in Singapore, we enrolled index patients with prior extraintestinal E. coli infections (17 with ST131, 17 with other sequence types) and their household coresidents. We collected sequential stool samples from 135 human participants and six companion animals and environmental swabs from 34 households. We identified nine carriers that persistently carried E. coli ST131 in high densities (57.79% of E. coli isolates per sample) for a median carriage duration of 86.35 days (80% credible interval (CrI) 30.03 to 188.80). Persistent carriers and their coresidents carried genetically similar E. coli ST131 isolates (median single nucleotide polymorphism distance 2, interquartile range 2 to 7), but persistent carriers harboured greater diversity, suggesting that they were the source of inter-individual transmissions. Our results highlight asymptomatic, persistent carriers as potential reservoirs sustaining community E. coli ST131 transmissions, offering a potential target for public health interventions such as vaccination to limit the spread of multidrug resistance.

Date: 2025
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DOI: 10.1038/s41467-025-63121-x

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