Escherichia coli bloodstream infection outcomes and preventability; a 6 month prospective observational study.
J Hosp Infect. 2019 May 23;:
Authors: Lillie PJ, Johnson G, Ivan M, Barlow GD, Moss PJ
BACKGROUND: Escherichia coli bloodstream infection (BSI) is a common and serious infection problem, with an incidence and antibiotic resistance increasing.
AIM: We sought to understand the drivers of outcomes and factors associated with preventable cases in our institution.
METHODS: Between 1st November 2017 and 30th April 2018, cases of E. coli BSI in adults treated as inpatients at our institution were included in a prospective cohort. Clinical, demographic and laboratory features were recorded, with 7, 30 and 90 day mortality recorded, together with length of hospital stay post BSI. Qualitative data on preventability were reviewed independently by 2 infection specialists.
FINDINGS: 195 cases in 188 patients were included in the analysis. Empirical antibiotics showed in vitro resistance in 30.9% of cases. 30 day mortality was 23.6%, with a median length of hospital stay of 7 days. In multivariable analysis 30 day mortality was associated with higher Charlson score, Residential home residence, higher respiratory rate and higher serum urea, whilst prolonged length of stay was associated with hospital acquired E. coli BSI. 50 patients were felt to have avoidable BSI, all of which were health care associated, with urinary catheter use, antibiotic related, and procedural complications being the areas of preventability.
CONCLUSIONS: E. coli BSI has an appreciable mortality, with little in the way of modifiable risk factors for mortality or prolonged hospital stay. Attention to urinary catheter use is likely to be the most useful way to reduce the incidence, but current UK reduction targets may be unachievable.
PMID: 31128970 [PubMed - as supplied by publisher]