Factors that impact on the burden of Escherichia coli bacteraemia: multivariable regression analysis of 2011–2015 data from West London

O. Blandy, K. Honeyford, M. Gharbi, A. Thomas, F. Ramzan, M. J. Ellington, R. Hope, A. H. Holmes, A. P. Johnson, P. Aylin, N. Woodford, S. Sriskandan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

Background: The incidence of Escherichia coli bacteraemia in England is increasing amid concern regarding the roles of antimicrobial resistance and nosocomial acquisition on burden of disease. Aim: To determine the relative contributions of hospital-onset E. coli bloodstream infection and specific E. coli antimicrobial resistance patterns to the burden and severity of E. coli bacteraemia in West London. Methods: Patient and antimicrobial susceptibility data were collected for all cases of E. coli bacteraemia between 2011 and 2015. Multivariable logistic regression was used to determine the association between the category of infection (hospital or community-onset) and length of stay, intensive care unit admission, and 30-day all-cause mortality. Findings: E. coli bacteraemia incidence increased by 76% during the study period, predominantly due to community-onset cases. Resistance to quinolones, third-generation cephalosporins, and aminoglycosides also increased over the study period, occurring in both community- and hospital-onset cases. Hospital-onset and non-susceptibility to either quinolones or third-generation cephalosporins were significant risk factors for prolonged length of stay, as was older age. Rates of mortality were 7% and 12% at 7 and 30 days, respectively. Older age, a higher comorbidity score, and bacteraemia caused by strains resistant to three antibiotic classes were all significant risk factors for mortality at 30 days. Conclusion: Multidrug resistance, increased age, and comorbidities were the main drivers of adverse outcome. The rise in E. coli bacteraemia was predominantly driven by community-onset infections, and initiatives to prevent community-onset cases should be a major focus to reduce the quantitative burden of E. coli infection.

Original languageEnglish
Pages (from-to)120-128
Number of pages9
JournalJournal of Hospital Infection
Volume101
Issue number2
DOIs
Publication statusPublished - Feb 2019

Bibliographical note

Funding Information:
We would like to thank colleagues from the NHS Departments of Microbiology and Infection Prevention and Control for helpful discussions and advice during this project. The authors also acknowledge the support of the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre .

Funding Information:
This research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in partnership with Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

Funding Information:
This research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in partnership with Public Health England (PHE) . The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

Funding Information:
We would like to thank colleagues from the NHS Departments of Microbiology and Infection Prevention and Control for helpful discussions and advice during this project. The authors also acknowledge the support of the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre.This research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in partnership with Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

Publisher Copyright:
© 2018 The Healthcare Infection Society

Keywords

  • Bacteraemia
  • Burden of disease
  • Escherichia coli
  • Gram negative
  • Risk factor

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