HlyF, an Underestimated Virulence Factor of Uropathogenicescherichia Coli

Urinary tract infections (UTIs) are predominantly caused by uropathogenic Escherichia coli (UPEC). By analysing a representative collection of UPEC strains from community-acquired infections, we showed that 20 % of these strains had the ability to produce the protein HlyF. These hlyF + UPEC strains were the most virulent, mostly responsible for pyelonephritis, often with bloodstream infections. Using a mouse model of UTI, we showed that HlyF was associated with the ability of UPEC to develop a urosepsis, with the presence of bacteria in the spleen and an exacerbated inflammatory response. In contrast to archetypical UPEC strains, hlyF + UPEC strains are not restricted to phylogroup B2 and harbor a specific repertoire of virulence factors reflecting the fact that HlyF is encoded by conjugative ColV-like plasmids. These plasmids also carry antimicrobial resistance genes, which may facilitate their selection and spreading amongst people receiving antimicrobial therapy. Overall, our data suggest that HlyF is a virulence factor in UPEC and spreading of ColV-like plasmids encoding hlyF warrants further investigation.