scholarly journals Autoimmune Neutropenia of Infancy- Unexpected Prevalence of Pseudomonas Skin Infections

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4940-4940
Author(s):  
Joanne Yacobovich ◽  
Neta Aviran Dagan ◽  
Tracie Goldberg ◽  
Orna Steinberg Shemer ◽  
Hannah Tamary
Keyword(s):  
Bacterial Infections ◽  
Blood Count ◽  
Conflicts Of Interest ◽  
Treatment Protocol ◽  
Prophylactic Antibiotic ◽  
Severe Neutropenia ◽  
Skin Infections ◽  
Autoimmune Neutropenia ◽  
Gram Negative ◽  
Tract Infections

Abstract Background: Autoimmune neutropenia of infancy (AIN), the most frequent type of severe neutropenia in young children, occurs due to recognition of membrane antigens by anti-neutrophil antibodies, resulting in peripheral neutrophil destruction. Despite the often severe and prolonged neutropenia, serious infectious complications are less frequent in AIN compared with other etiologies of severe neutropenia. Objectives and methods: The purpose of this historical prospective study was to describe the demographics and clinical course of AIN with a focus on the incidence of infectious events, the pathogens involved and assessment of contributing factors. Data was extracted from the medical records of AIN patients treated at the pediatric hematology clinic in Schneider Children's Medical Center of Israel between 2001-2016. Results: One hundred and one patients diagnosed with AIN were included in the study, representing a total of 175 patient-years of follow-up, with a mean of 1.9 years per patient. Mean age at presentation was 0.8 years and at resolution 2.8 years; 90% were healthy by the age 3.8 years. The reason for performing a blood count was febrile infection in 56.3% while nearly 20% were diagnosed by the routine blood count performed between ages 9-12 months in the well-baby clinic. Prophylactic antibiotic use did not correlate with the number of infectious events or days of fever. At least one microbiologically proven bacterial infection was identified in 26% of the patients including acute otitis, urinary tract infections, skin lesions and bacteremia. Bacterial isolates were mostly gram negative, predominantly Pseudomonas species (13/32, 40.6% of isolates) (Figure 1). Prevalence of significant skin infections, especially in the genital region, was very high (20% of infections). There were only 3 episodes of bacteremia out of 559 total febrile illnesses (0.5%). Discussion and conclusions: A standard treatment protocol for AIN is lacking, possibly due to a paucity of data in the literature. Severe bacterial infections in AIN are less common than in severe congenital neutropenia or chemotherapy induced neutropenia. The prevalence of bacteremia in AIN is not well defined in the post-pneumococcal vaccine era. In our cohort bacteremia was uncommon, while bacterial skin infections were much more prevalent, especially involving the genital area, with a high isolation rate of gram negative bacteria, especially Pseudomonas sp. This finding was surprising as ecthymal lesions are more commonly associated with hypoproductive neutropenias. The common practice of treating febrile illnesses in AIN with broad spectrum antibiotics may be unnecessary for a proportion of patients, while a subset of patients seems to be susceptible to gram negative skin infections and should be covered with anti-pseudomonal antibiotics. We recommend that patients with AIN and a febrile illness undergo a careful daily physical examination in addition to laboratory studies including blood counts and cultures of blood, urine and any other suspected sites of infection. Antibiotic therapy should be prescribed according to the clinical picture and the laboratory results. Disclosures No relevant conflicts of interest to declare.

scholarly journals Cefiderocol for Extensively Drug-Resistant Gram-Negative Bacterial Infections: Real-world Experience From a Case Series and Review of the Literature

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Sandra Zingg ◽  
G Jacopo Nicoletti ◽  
Sabine Kuster ◽  
Milena Junker ◽  
Andreas Widmer ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Case Reports ◽  
Case Series ◽  
Gram Negative Bacteria ◽  
Drug Resistant ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Extensively Drug Resistant ◽  
Health Care Associated Infections ◽  
Tract Infections

Abstract Cefiderocol is a new siderophore cephalosporin with activity against carbapenem-resistant gram-negative bacteria. Data on its clinical efficacy are limited to complicated urinary tract infections. We present a series of 3 patients successfully treated with cefiderocol for complicated health care–associated infections and review published case reports.

scholarly journals Clinical Outcomes and Healthcare Utilization Related to Multidrug-Resistant Gram-Negative Infections in Community Hospitals

2016 ◽  
Vol 38 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Kristen V. Dicks ◽  
Deverick J. Anderson ◽  
Arthur W. Baker ◽  
Daniel J. Sexton ◽  
Sarah S. Lewis
Keyword(s):  
Bacterial Infections ◽  
Multidrug Resistant ◽  
Healthcare Resource Utilization ◽  
Community Hospitals ◽  
Readmission Rates ◽  
Gram Negative ◽  
Mortality Difference ◽  
Tract Infections ◽  
Multivariable Regression Models ◽  
The Impact

OBJECTIVETo evaluate the impact of multidrug-resistant gram-negative rod (MDR-GNR) infections on mortality and healthcare resource utilization in community hospitals.DESIGNTwo matched case-control analyses.SETTINGSix community hospitals participating in the Duke Infection Control Outreach Network from January 1, 2010, through December 31, 2012.PARTICIPANTSAdult patients admitted to study hospitals during the study period.METHODSPatients with MDR-GNR bloodstream and urinary tract infections were compared with 2 groups: (1) patients with infections due to nonMDR-GNR and (2) control patients representative of the nonpsychiatric, non-obstetric hospitalized population. Four outcomes were assessed: mortality, direct cost of hospitalization, length of stay, and 30-day readmission rates. Multivariable regression models were created to estimate the effect of MDR status on each outcome measure.RESULTSNo mortality difference was seen in either analysis. Patients with MDR-GNR infections had 2.03 higher odds of 30-day readmission compared with patients with nonMDR-GNR infections (95% CI, 1.04–3.97, P=.04). There was no difference in hospital direct costs between patients with MDR-GNR infections and patients with nonMDR-GNR infections. Hospitalizations for patients with MDR-GNR infections cost $5,320.03 more (95% CI, $2,366.02–$8,274.05, P<.001) and resulted in 3.40 extra hospital days (95% CI, 1.41–5.40, P<.001) than hospitalizations for control patients.CONCLUSIONSOur study provides novel data regarding the clinical and financial impact of MDR gram-negative bacterial infections in community hospitals. There was no difference in mortality between patients with MDR-GNR infections and patients with nonMDR-GNR infections or control patients.Infect Control Hosp Epidemiol 2016;1–8

Bacterial Pattern of Community acquired Urinary Tract Infections: A Challenge for Antimicrobial Resistance

2021 ◽  
Vol 30 (3) ◽  
pp. 153-162
Author(s):  
Nader A. Nemr ◽  
Rania M. Kishk ◽  
Mohammed Abdou ◽  
Hassnaa Nassar ◽  
Noha M Abu bakr Elsaid ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Resistance ◽  
Bacterial Infections ◽  
Diffusion Method ◽  
Gram Negative Bacteria ◽  
Isolation And Identification ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Tract Infections

Background: Urinary tract infection (UTI) is considered one of the most common bacterial infections seen in health care. To our knowledge, there is no available antimicrobial resistance surveillance system for monitoring of community-acquired UTIs (CA- UTIs) in our country. Objectives: we aimed to discuss the bacterial pattern and resistance profile of CA-UTIs in Ismailia, Egypt. Methods: This cross-sectional study included 400 patients suffering from symptoms of acute UTIs. Urine specimens were collected by clean-catch mid-stream method, examined microscopically and inoculated immediately on blood agar and MacConkey's agar plates. Colony counting, isolation and identification of the urinary pathogens were performed by the conventional biochemical tests according to the isolated organism. Antibiotic susceptibility testing was performed by Kirby Bauer disk diffusion method. Interpretation was performed according to Clinical Laboratory Standard Institute (CLSI) guidelines. Results: out of 400 specimens, 136 of them revealed no bacterial growth or insignificant bacteriuria. Most of participants with UTI were females (81.8%) (p=0.008) and 54.5% of them were married (P=0.1). Gram negative bacteria were more common than Gram positive representing 66 % and 34% respectively. E. coli was the most common isolated organism (39%) followed by S. aureus (32%), K. Pneumoniae and Pseudomonas (10.5% for each), Proteus (6%) and Enterococci (2%). E. coli isolates showed the highest susceptibility to imipenem, meropenem, amikacin, nitrofurantoin, levofloxacin and ciprofloxacin. Most of our patients were diabetics (64.8%) (p=0.004). The mean ± SD of HbA1c was 6.4±2.0 with 4 to 12.6 range, S.E was 0.1 and 95% C.I was 6.2- 6.7. The highest mean ± SD of HbA1c was in S. aureus infections. Conclusion: Gram negative bacteria were most common than Gram positive with predominance of E. coli with significant relation to the presence of diabetes.

scholarly journals 1575. Predictors of Negative Clinical Outcomes among Patients treated with Meropenem-Vaborbactam for Serious Gram-Negative Bacterial Infections: Impact of Delayed Appropriate Antibiotic Selection

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S786-S786
Author(s):  
Sara Alosaimy ◽  
Abdalhamid M Lagnf ◽  
Sarah Jorgensen ◽  
Travis J Carlson ◽  
Jinhee Jo ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Bacterial Infections ◽  
The United States ◽  
Research Support ◽  
Gram Negative ◽  
Appropriate Therapy ◽  
Tract Infections ◽  
The Impact

Abstract Background Numerous number of studies have found a positive correlation between delayed appropriate antibiotic therapy and negative clinical outcomes (NCO) in Gram-negative bacterial infections (GNBI). The combination of meropenem with vaborbactam (MVB) received Food and Drug Administration approval for the treatment of complicated urinary tract infections and acute pyelonephritis caused by susceptible organisms in August 2017. We sought to determine the impact of delayed appropriate therapy with MVB on NCO among patients with GNBI. Methods Multi-center, retrospective cohort study from October 2017 to March 2020. We included adult patients treated with MVB for &gt;72 hours. We excluded patients who received alternative appropriate antibiotics for GNB prior to MVB and patients with unknown dates for index culture. NCO were defined as 30-day mortality and/or microbiological recurrence. All outcomes were measured from MVB start date. Classification and regression tree analysis (CART) was used to identify the time breakpoint (BP) that delineates the risk of NCO. Multivariable logistic regression analysis (MLR) was used to examine the independent association between the CART-derived-BP and NCO. Variables were retained in the model if P&lt; 0.2 and removed in a backward stepwise approach. Results A total of 86 patients were included from 13 institutions in the United States: median(IQR) age 55 (37-67) years, 67% male, and 48% Caucasian. Median(IQR) APACHE II and Charlson Comorbidity index scores were 18(11-26) and 4(2-6), respectively. Common sources of infection were respiratory (37%) and intra-abdominal (21%). The most common pathogens were carbapenem-resistant Enterobacterales (83%). CART-derived BP between early and delayed treatment was 48 hours, where NCO was increased (36% vs.7%; P=0.04). Delayed MVB initiation was independently associated with NCO in the MLR (aOR=7.4, P=0.02). Results of Regression Analysis of Variables Associated With Negative Clinical Outcomes and Delayed Appropriate Therapy with Meropenem-vaborbactam Conclusion Our results suggest that delaying appropriate antibiotic therapy with MVB for &gt;48 hours significantly increases the risk of NCO in patients with GNBI. Clinicians must ensure timely administration of MVB to assure best outcomes in patients with GNBI. Disclosures Kevin W. Garey, PharMD, MS, FASHP, Merck & Co. (Grant/Research Support, Scientific Research Study Investigator) Michael J. Rybak, PharmD, MPH, PhD, Paratek (Grant/Research Support)

scholarly journals Antibiotic Susceptibility Patterns of Uropathogens Isolated from Female Patients with Urinary Tract Infection in Duhok Province, Iraq

2020 ◽  
Vol 12 (3) ◽  
Author(s):  
Ibrahim A Naqid ◽  
Nawfal R Hussein ◽  
Amer Balatay ◽  
Kurdistan A Saeed ◽  
Hiba A Ahmed
Keyword(s):  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Bacterial Infections ◽  
Antimicrobial Agents ◽  
Empirical Therapy ◽  
Urine Samples ◽  
Gram Positive ◽  
Gram Negative ◽  
Female Patients ◽  
Tract Infections

Background: Urinary Tract Infections (UTIs) are one of the most common bacterial infections worldwide. The study of bacterial uropathogens in a local area and their susceptibility to antimicrobial agents is required to determine empirical therapy. Objectives: This study aimed to assess the profile and antibiotic resistance patterns of bacteria, causing urinary infections isolated from female patients in Duhok province, Iraq. Methods: A total of 530 urine samples were collected from females clinically suspected of UTIs over three years between January 2017 and February 2020. The samples were inoculated directly on MacConkey and Blood agar media and then incubated aerobically for 24 h at 37°C. Samples that gave up colony counts of ≥ 105 CFU/mL were considered as positive growth. Purified colonies were identified through standard bacteriological tests, and their susceptibility to different antibiotics was determined using the Vitek-2 system. Results: Out of 530 urine samples, 450 (84.9%) contained Gram-negative bacteria, while the other 80 (15.1%) harbored Gram-positive bacteria. Escherichia coli was the most common uropathogenic isolate (58.5%), followed by K. pneumoniae (14.3%), Staphylococcus spp. (8.9%), P. mirabilis (6.6%), E. faecalis (3.2%), and S. agalactiae (3.02%). The majority of Gram-negative uropathogens were resistant to ampicillin, aztreonam, ceftriaxone, and cefepime and around 95% were sensitive to ertapenem and imipenem. Most Gram-positive isolates showed high resistance to benzylpenicillin, oxacillin, gentamicin, and erythromycin, and high susceptibility to linezolid, tigecycline, and nitrofurantoin. Conclusions: It was concluded from this study that E. coli is the predominant pathogen causing UTIs in female patients in Duhok province, Iraq. There were increasing antibiotic resistance rates, particularly to ampicillin, aztreonam, ceftriaxone, benzylpenicillin, and erythromycin. Therefore, empirical antibiotic therapy should be based on local sensitivity patterns rather than international guidelines.

scholarly journals Prevalence and Antibiotic Sensitivity pattern of Bacterial Isolates from Catheterized UTI Patients: A Local Study

2021 ◽  
Vol 2 (2) ◽  
pp. 229-235
Author(s):  
Iqra Arooj ◽  
Alishba Sehar ◽  
Asghar Javaid
Keyword(s):  
Bacterial Infections ◽  
Bacterial Species ◽  
Local Population ◽  
Bacterial Isolates ◽  
Biochemical Tests ◽  
Gram Positive ◽  
Local Study ◽  
Gram Negative ◽  
Sensitivity Pattern ◽  
Tract Infections

Prevalence and multidrug resistance among bacteria in catheter-associated urinary tract infections (CAUTIs) has been on the rise in recent times. Hence, the prevalence rate and antibacterial susceptibility of bacteria in CAUTIs in ICU patients was evaluated. A total of 120 patients admitted to the ICU of Nishtar Hospital, Multan, were recruited for this study. Both gram-positive and gram-negative bacterial isolates were characterized based on biochemical tests including catalase test, oxidase test, indole test, TSI test, citrate test, coagulase test and growth on 6.5% NaCl agar. The prevalence of bacterial species was Escherichia coli (32%), Staphylococcus aureus (26%), Pseudomonas spp. (18%), Proteus spp. (14%) and Enterococcus spp. (2%). A considerable degree of resistance against commonly prescribed antibiotics was observed. Gram negative bacteria showed resistance to ciprofloxacin, piperacillin-tazobactam and amikacin as well as susceptibility to imipenem, tigecycline and polymixin. Gram positive bacteria showed resistance to antibiotics such as piperacillin-tazobactam, ampicillin, gentamicin, oxacillin and ceftazidime suggesting the ineffectiveness of these antibiotics for treating bacterial infections among CAUTI patients and demonstrating the latest trends in antimicrobial drug resistance profile in local population.

Upper and Lower Respiratory Tract Infections By Respiratory Viruses in Adult Recipients of Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5479-5479 ◽  
Author(s):  
Erden Atilla ◽  
Pinar Ataca ◽  
Didem Sahin ◽  
Pervin Topcuoglu ◽  
Istar Dolapci ◽  
...  
Keyword(s):  
Neutrophil Count ◽  
Lymphocyte Count ◽  
Bacterial Infections ◽  
Conflicts Of Interest ◽  
Respiratory Viruses ◽  
Late Time ◽  
Viral Agent ◽  
Hematopoietic Stem ◽  
Tract Infections ◽  
Cmv Reactivation

Abstract Introduction: Respiratory viruses are known to be the major causes of morbidity and mortality in recipients of Allo-HSCT. In this study, we evaluated the results of respiratory viral panel in the patients after Allo-HSCT, having the symptoms and/or findings of upper or lower respiratory infections. Patients&Methods: In our center, the examination of the respiratory viral panel has been routinely performing in the patients having the symptoms and/or findings of upper or lowers respiratory infection since January 2013. We retrospectively evaluated the results of respiratory viral panel in 39 patients (24 M/ 15F) who underwent allo-HSCT for benign (n=4) or malign (n=35) hematological disease. Median age was 39 years (range, 20-67). Nasopharyngeal aspirates were used for obtaining upper respiratory specimens for respiratory viral panel. Viral panel was studied with PCR method, Seeplex RV 15 ACE Detectionkit (Seegene, Korea). Adenovirus A/B/C/D/E, Coronavirus 229E/NL63, Coronavirus OC43/HKU1, Parainfluenza virus 1,2,3,4, Rhinovirus A/B/C, Influenza A ve B virus, Respiratory Syncytial virus (RSV) A ve B, Boca virus 1/2/3/4, Metapneumovirus and Enterovirus can be detected with this technique. The sensitivity of the method is 5500 copies per ml. Results: We detected the viral panel positivity in 25 patients with median 140 days (range: 3-617 days) after the transplantation. The most frequent viral agent disclosed was RSV and parainfluenza (32 %; n=7) followed by Coronavirus (n=6), Rhinovirus (n=5), Influenza (n=3),H1N1 (n=1), Metapneumovirus (n=1) and Adenovirus (n=1). In five patients two viruses were detected concurrently (1 Rhinovirus plus influenza; 2 RSV plus Coronovirus; 1 Rhino plus RSV; 1 Parainfluenza plus Rhino; and 1 Parainfluenza plus Coronovirus). Although CMV reactivation was occurred in 4 patients at the time of viral panel positivity, there was no statistical correlation between CMV reactivation and respiratory viral panel positivity (p=0.11). Most of the patients (n=20) with viral panel positivity were under immunosuppressive therapy for graft versus host disease prophylaxis or treatment. In 7 of 25 viral panel positive patients, bacterial infections were accompanied. 15 viral panel positive patients were diagnosed as pneumonia by radiological imaging. In addition, viral panel positive patients have significantly lower lymphocyte counts (p=0.013)(Table 1). Conclusion: Parainfluenza and RSV are the most common viral agent detected similar to prior studies. Although viral panel positive patients have lower neutrophil count accompanied by higher CRP, the difference was not found to be statistically significant. CMV reactivation is not related with viral panel positivity. But the lymphocyte count was lower in the patients having positive results. In viral panel negative patients, high CRP levels might show infections rather than virus in etiology. The limitations of our study were that few patients were able to be evaluated in, and also the evaluations had both early and late time-period of the transplantation. Nevertheless, we thought that the results should give an opinion about the development of respiratory viral infections to the clinicians. Table 1. The comparisons of the other laboratory parameters in the patients with viral panel positive with the negative ones. Patients Lymphocyte count (10e6/L), (range) Neutrophil count (10e6/L), (range) CRP mg/dl, range Viral panel positive 1056(0-6500) 1656 (0-8100) 124 (1-506) Viral panel negative 3092 (0-6034) 2621 (0-15700) 67 (21-174) P 0.013 0.063 0.250 Disclosures No relevant conflicts of interest to declare.

scholarly journals Healthcare-associated bacterial infections in the paediatric ICU

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Olugbenga Akinkugbe ◽  
Fiona J Cooke ◽  
Nazima Pathan
Keyword(s):  
Length Of Stay ◽  
Critically Ill ◽  
Bacterial Infections ◽  
Klebsiella Oxytoca ◽  
Critically Ill Children ◽  
Tertiary Referral Centre ◽  
Gram Negative ◽  
Gram Negative Organisms ◽  
Tract Infections ◽  
Healthcare Associated

Abstract Background An estimated 3.2 million patients annually develop healthcare-associated infections (HCAIs) in Europe alone amid the major challenge of increasing antimicrobial resistance. Critically ill children warrant specific evaluation because of differences in epidemiology, causative organisms and infection sites. Objectives To examine the prevalence and antimicrobial susceptibility patterns of three types of HCAI in critically ill children and determine the effect on their disease course. Materials and methods Retrospective cohort review of critically ill children admitted to a general paediatric ICU (PICU) at a regional academic tertiary referral centre over a 3 year period. Results There were 1930 admissions with a median age of 38 months. Children with HCAIs had a higher incidence of comorbidities (74% versus 24%) and a longer median length of stay (8 days versus 3 days). We identified 26 positive isolates (blood, lower respiratory and urine) taken 48 h or more after admission. The combined incidence was 1.34%. Hospital-acquired pneumonia accounted for 58% of HCAIs, urinary tract infections for 31% and bloodstream infections for 11%. The majority (61.5%) of HCAIs were caused by Gram-negative organisms. Seven isolates were resistant to antimicrobials used to treat HCAI. All of these were Gram-negative organisms (Pseudomonas aeruginosa, Klebsiella oxytoca and Escherichia coli). Conclusions These data revealed a low incidence of HCAIs, 27% of which were resistant Gram-negative organisms. Critically ill children with HCAIs were more likely to have comorbidities and an increased length of stay. These factors may increasingly impact on PICU bed availability, an already limited resource.

scholarly journals Pilicide ec240 Disrupts Virulence Circuits in Uropathogenic Escherichia coli

mBio ◽  
2014 ◽  
Vol 5 (6) ◽  
Author(s):  
Sarah E. Greene ◽  
Jerome S. Pinkner ◽  
Erik Chorell ◽  
Karen W. Dodson ◽  
Carrie L. Shaffer ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Virulence Factors ◽  
Bacterial Infections ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Content Type ◽  
Pilus Biogenesis ◽  
Altered Regulation ◽  
Tract Infections

ABSTRACTChaperone-usher pathway (CUP) pili are extracellular organelles produced by Gram-negative bacteria that mediate bacterial pathogenesis. Small-molecule inhibitors of CUP pili, termed pilicides, were rationally designed and shown to inhibit type 1 or P piliation. Here, we show that pilicide ec240 decreased the levels of type 1, P, and S piliation. Transcriptomic and proteomic analyses using the cystitis isolate UTI89 revealed that ec240 dysregulated CUP pili and decreased motility. Paradoxically, the transcript levels of P and S pilus genes were increased during growth in ec240, even though the level of P and S piliation decreased. In contrast, the most downregulated transcripts after growth in ec240 were from the type 1 pilus genes. Type 1 pilus expression is controlled by inversion of thefimSpromoter element, which can oscillate between phase on and phase off orientations. ec240 induced thefimSphase off orientation, and this effect was necessary for the majority of ec240’s inhibition of type 1 piliation. ec240 increased levels of the transcriptional regulators SfaB and PapB, which were shown to induce thefimSpromoter phase off orientation. Furthermore, the effect of ec240 on motility was abolished in the absence of the SfaB, PapB, SfaX, and PapX regulators. In contrast to the effects of ec240, deletion of the type 1 pilus operon led to increased S and P piliation and motility. Thus, ec240 dysregulated several uropathogenicEscherichia coli(UPEC) virulence factors through different mechanisms and independent of its effects on type 1 pilus biogenesis and may have potential as an antivirulence compound.IMPORTANCECUP pili and flagella play active roles in the pathogenesis of a variety of Gram-negative bacterial infections, including urinary tract infections mediated by UPEC. These are extremely common infections that are often recurrent and increasingly caused by antibiotic-resistant organisms. Preventing piliation and motility through altered regulation and assembly of these important virulence factors could aid in the development of novel therapeutics. This study increases our understanding of the regulation of these virulence factors, providing new avenues by which to target their expression.

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