Factors that impact on the burden of Escherichia coli bacteraemia: multivariable regression analysis of 2011-2015 data from West London.
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.
['Blandy|O|O|', 'Honeyford|K|K|', 'Gharbi|M|M|', 'Thomas|A|A|', 'Ramzan|F|F|', 'Ellington|M J|MJ|', 'Hope|R|R|', 'Holmes|A H|AH|', 'Johnson|A P|AP|', 'Aylin|P|P|', 'Woodford|N|N|', 'Sriskandan|S|S|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D016470:Bacteremia D024881:Drug Resistance, Bacterial D004926:Escherichia coli D004927:Escherichia coli Infections D005260:Female D006801:Humans D015994:Incidence D007902:Length of Stay D008131:London D008297:Male D008826:Microbial Sensitivity Tests D008875:Middle Aged D012044:Regression Analysis D012189:Retrospective Studies D012307:Risk Factors D016019:Survival Analysis D055815:Young Adult
Escherichia coli Bacteraemia Burden of disease Risk factor Gram negative