There is a significant burden of health care due to extra-intestinal surgical intervention Escherichia coli infectious disease (IEI) in hospitals in the United States, according to a report published in Clinical Infectious Diseases.
Data from the Premier Healthcare Solutions database, which contains details of a quarter of hospital visits in the United States, were analyzed for this retrospective, observational study. Patients (N = 37,207,510) who visited the hospital between 2009 and 2016 were evaluated for IEI and evidence of antibiotic resistance.
These patients visited 236 hospitals on 14,494,725 occasions. IEI was found during 71,909 visits (0.19%) among 67,583 patients (0.18%).
At baseline, 39.8% of IEI patients were men, 55.6% were over 65 years of age, and 68.2% were white. Of the 86% of patients treated as inpatients at the IEI, 81.3% were admitted through the emergency department. 60.5% went home, 26.5% to a nursing facility, and 8.4% died. More than 14% (n = 9415) of patients were identified as outpatients.
Common IEI diagnoses were urinary sepsis (66.0%), other bloodstream infections (22.1%), and wound infection (6.8%). IEI was determined to be hospitalization among 8.7% and health-acquired among 24.9%.
IEI recurred between 30.2 events per 1000 patients. Prostate biopsy increased recurrence rates (136.4 events per 1000 patients).
Among patients with a recurrence (n = 1764), the mean time to first recurrence was 117.2 ± 96.1 days. Recurrence occurred sooner among patients who underwent prostate biopsy, compared with other bloodstream infections, complicated pneumonia, or urine sepsis.
Among patients evaluated for sensitivity to antibiotics (n = 41696), 28.22% were resistant to fluoroquinolone, 9.18% were resistant to extended-spectrum cephalosporins, and 0.14% were resistant to carbapenems. According to hospitalization history, resistance to extended-spectrum cephalosporins increased from 5.46% in 2009 to 12.97% in 2016 (s <.05).
This study may be biased by considering only the frequency among patients readmitted to the same hospital.
These results indicated that older inpatients were at an elevated risk for IEI, the most common cause of urotoxicity or other bloodstream infections. Resistance to fluoroquinolone antibiotics has been relatively common (>25%) and resistance to extended-spectrum cephalosporins has been increasing in recent decades. Additional studies for IEI prevention are needed in the United States.
Disclosure: Several authors have declared industry affiliation. Please refer to the original article for a full list of disclosures.
Begier E, Rosenthal NA, Gurtman A et al. Invasive Epidemiology Escherichia coli Infection status and antibiotic resistance among patients treated in US hospitals: 2009-2016. clen infect dis. 2021; ciab005. doi: 10.1093/cid/ciab005.