Epidemiology of Invasive Escherichia coli Infection and Antibiotic Resistance Status among Patients Treated in U.S. Hospitals: 2009-2016

Link to article at PubMed

Clin Infect Dis. 2021 Jan 9:ciab005. doi: 10.1093/cid/ciab005. Online ahead of print.


BACKGROUND: Published data is limited on the prevalence and risk of recurrence of extraintestinal invasive E. coli infections (IEIs) in the United States.

METHODS: All inpatient and hospital-based outpatient visits occurring between 2009-2016 at hospitals with continuous microbiology data submission to the Premier Healthcare Database for 90 days prior to the admission/visit and 12 months following it were included in analysis. IEI was defined as having positive E. coli culture from a normally sterile site (e.g., blood, cerebrospinal fluid). Prevalence of IEI, 12-month risk of recurrent IEI, and antibiotic resistance were assessed.

RESULTS: Overall, 144,944,725 hospital visits among 37,207,510 patients were analyzed, and 71,909 IEI events occurred in 67,583 patients, corresponding to an IEI prevalence of 0.50 events/1000 visits and 1.82 events/1000 patients. Recurrence was common: 26.9 per 1000 patients had a recurrent IEI in the 12 months following their infection. Most infections were community-acquired (66.4%), and urosepsis was most common clinical syndrome (66.0%). 30- day risk of IEI among patients undergoing Transrectal Ultrasound Guided Prostate Biopsy was high: 5.03 events/1000 patients. Among all IEI cases with antibiotic susceptibility testing, 9.18% were resistant to extended-spectrum cephalosporins (ESC4), 28.22% to Fluoroquinolones (FQ3), and 0.14% to carbapenems. ESC4 resistance increased from 5.46% to 12.97% during the eight- year study period.

CONCLUSIONS: This real-world study indicates a substantial burden of IEI and recurrent IEI exists in the Unites States as well as increasing resistance to ESC4. Future research should explore risk factors of recurrent IEI aiming to effectively prevent such infections.

PMID:33420788 | DOI:10.1093/cid/ciab005

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