Epidemiology, Clinical Features, and Antimicrobial Resistance of Invasive Escherichia Coli Disease in Patients Admitted in Tertiary Care Hospitals

Joachim Doua¹, Jeroen Geurtsen², Jesus Rodriguez-Baño^{3

4

5

6}, Oliver A Cornely^{7

8

9

10}, Oscar Go¹¹, Aina Gomila-Grange^{12

13}, Andrew Kirby¹⁴, Peter Hermans¹⁵, Andrea Gori¹⁶, Valentina Zuccaro¹⁷, Stefan Gravenstein¹⁸, Marc Bonten¹⁹, Jan Poolman², Michal Sarnecki²⁰

Affiliations

¹ Janssen Research & Development, Infectious Diseases & Vaccines, Janssen Pharmaceutica, Beerse, Belgium.
² Bacterial Vaccines Discovery and Early Development, Janssen Vaccines & Prevention B.V., Leiden, The Netherlands.
³ Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.
⁴ Department of Medicine, University of Sevilla, Seville, Spain.
⁵ Biomedicine Institute of Sevilla/CSIC, Seville, Spain.
⁶ CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
⁷ Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.
⁸ Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.
⁹ Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
¹⁰ German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
¹¹ Janssen Research & Development, Raritan, New Jersey, USA.
¹² Infectious Diseases Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
¹³ Infectious Diseases Department, Hospital Parc Taulí de Sabadell, Parc Tauli, Barcelona, Spain.
¹⁴ Leeds Institute of Medical Research, The University of Leeds, Old Medical School, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom.
¹⁵ Julius Center for Health Sciences and Primary Care University Medical Center, Utrecht University, Utrecht, The Netherlands.
¹⁶ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
¹⁷ Infectious Diseases Department, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Lombardy, Italy.
¹⁸ Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
¹⁹ Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
²⁰ Clinical Development, Janssen Vaccines, Bern, Switzerland.

PMID: 36817744
PMCID: PMC9933942
DOI: 10.1093/ofid/ofad026

Epidemiology, Clinical Features, and Antimicrobial Resistance of Invasive Escherichia Coli Disease in Patients Admitted in Tertiary Care Hospitals

Joachim Doua et al. Open Forum Infect Dis. 2023.

. 2023 Jan 27;10(2):ofad026.

doi: 10.1093/ofid/ofad026. eCollection 2023 Feb.

Authors

Affiliations

¹ Janssen Research & Development, Infectious Diseases & Vaccines, Janssen Pharmaceutica, Beerse, Belgium.
² Bacterial Vaccines Discovery and Early Development, Janssen Vaccines & Prevention B.V., Leiden, The Netherlands.
³ Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.
⁴ Department of Medicine, University of Sevilla, Seville, Spain.
⁵ Biomedicine Institute of Sevilla/CSIC, Seville, Spain.
⁶ CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
⁷ Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.
⁸ Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.
⁹ Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
¹⁰ German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
¹¹ Janssen Research & Development, Raritan, New Jersey, USA.
¹² Infectious Diseases Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
¹³ Infectious Diseases Department, Hospital Parc Taulí de Sabadell, Parc Tauli, Barcelona, Spain.
¹⁴ Leeds Institute of Medical Research, The University of Leeds, Old Medical School, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom.
¹⁵ Julius Center for Health Sciences and Primary Care University Medical Center, Utrecht University, Utrecht, The Netherlands.
¹⁶ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
¹⁷ Infectious Diseases Department, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Lombardy, Italy.
¹⁸ Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
¹⁹ Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
²⁰ Clinical Development, Janssen Vaccines, Bern, Switzerland.

PMID: 36817744
PMCID: PMC9933942
DOI: 10.1093/ofid/ofad026

Abstract

Background: Invasive Escherichia coli disease (IED), including bloodstream infection, sepsis, and septic shock, can lead to high hospitalization and mortality rates. This multinational study describes the clinical profile of patients with IED in tertiary care hospitals.

Methods: We applied clinical criteria of systemic inflammatory response syndrome (SIRS), sepsis, or septic shock to patients hospitalized with culture-confirmed E coli from urine or a presumed sterile site. We assessed a proposed clinical case definition against physician diagnoses.

Results: Most patients with IED (N = 902) were adults aged ≥60 years (76.5%); 51.9%, 25.1%, and 23.0% of cases were community-acquired (CA), hospital-acquired (HA), and healthcare-associated (HCA), respectively. The urinary tract was the most common source of infection (52.3%). Systemic inflammatory response syndrome, sepsis, and septic shock were identified in 77.4%, 65.3%, and 14.1% of patients, respectively. Patients >60 years were more likely to exhibit organ dysfunction than those ≤60 years; this trend was not observed for SIRS. The case-fatality rate (CFR) was 20.0% (60-75 years, 21.5%; ≥75 years, 22.2%), with an increase across IED acquisition settings (HA, 28.3%; HCA, 21.7%; CA, 15.2%). Noticeably, 77.8% of patients initiated antibiotic use on the day of culture sample collection. A total of 65.6% and 40.8% of E coli isolates were resistant to ≥1 agent in ≥1 or ≥2 drug class(es). A 96.1% agreement was seen between the proposed clinical case definition and physician's diagnoses of IED.

Conclusions: This study contributes valuable, real-world data about IED severity. An accepted case definition could promote timely and accurate diagnosis of IED and inform the development of novel preventative strategies.

Keywords: Escherichia coli; blood culture; sepsis; septicemia.

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Conflict of interest statement

Potential conflicts of interest. J. D., J. G., O. G., J. P., and M. S. are employees of Janssen and receive Janssen stock. P. H. was an employee of Janssen from 2012 to 2019 and since 2019 has been a Full Professor at UMC Utrecht. M. B. is chair of the international study steering committee for the E.mbrace study (Janssen Vaccines), with payments made to UMC Utrecht. S. G. consults/advises for Janssen. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

**Figure 1.**
Case-fatality rate and causes of death in 902 patients with invasive *Escherichia coli* disease. Other = unknown reason (11 patients), peritonitis (4 patients), septicemia (4 patients), pneumonia (4 patients), cardiovascular reasons (3 patients), renal insufficiency (2 patients), multiple organ failure (2 patients), and low digestive bleeding, liver cirrhosis, cerebral hemorrhage, hemorrhagic shock, and adenocarcinoma (all in 1 patient each). N, number of patients in the specified category.

See this image and copyright information in PMC

References

1. Russo TA, Johnson JR. Medical and economic impact of extraintestinal infections due to Escherichia coli: focus on an increasingly important endemic problem. Microbes Infect 2003; 5:449–56. - PubMed
1. Poolman JT, Wacker M. Extraintestinal pathogenic Escherichia coli, a common human pathogen: challenges for vaccine development and progress in the field. J Infect Dis 2016; 213:6–13. - PMC - PubMed
1. Russo TA, Johnson JR. Proposal for a new inclusive designation for extraintestinal pathogenic isolates of Escherichia coli: ExPEC. J Infect Dis 2000; 181:1753–4. - PubMed
1. Rosenberg S, Bonten M, Haazen W, et al. . Epidemiology and O-serotypes of extraintestinal pathogenic Escherichia coli disease in patients undergoing transrectal ultrasound prostate biopsy: a prospective multicenter study. J Urol 2021; 205:826–32. - PubMed
1. Geurtsen J, de Been M, Weerdenburg E, Zomer A, McNally A, Poolman J. Genomics and pathotypes of the many faces of Escherichia coli. FEMS Microbiol Rev 2022; 46:fuac031. - PMC - PubMed

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Epidemiology, Clinical Features, and Antimicrobial Resistance of Invasive Escherichia Coli Disease in Patients Admitted in Tertiary Care Hospitals

Affiliations

Epidemiology, Clinical Features, and Antimicrobial Resistance of Invasive Escherichia Coli Disease in Patients Admitted in Tertiary Care Hospitals

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

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