Study outlines characteristics of invasive E. coli disease by setting, age, outcome
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A recent study published in Open Forum Infectious Diseases outlined the clinical characteristics of invasive Escherichia coli disease by stratifying cases by acquisition setting, patient age and infection outcome.
“Escherichia coli is a commensal bacterium from the gastrointestinal tract (GI). However, pathogenic strains of E. coli cause significant morbidity and are one of the leading causes of deaths linked to bacterial infections, globally,” a representative from Janssen told Healio. “E. coli strains that can move outside of the GI tract and infect otherwise sterile parts of the body are called extraintestinal pathogenic E. coli and can cause invasive E. coli disease (IED.”
According to the representative, the incidence of invasive disease caused by E. coli is “significant” and has been steadily increasing over the last decades.
This is especially true among older adults, although previous UTIs, many of which are also caused by E. coli, and chronic diseases such as chronic obstructive pulmonary disease, diabetes, chronic kidney disease, renal dialysis, chronic liver disease, and certain cardiovascular disease are “key risk factors for developing IED.”
They further explained that IED can present as severe complicated UTIs, sepsis, meningitis, surgical site infections, abdominal and pelvic infections and nosocomial pneumonia that leads to invasive disease, making it a “very serious condition” and leading to significant morbidity and mortality, with around 10% of all cases of IED being fatal.
In order to help better understand the clinical profile of IED, researchers performed a retrospective, multicenter, noninterventional cohort study to best describe the clinical characteristics of IED in patients from hospitals in eight countries — Canada, the U.S., Japan, France, Germany, Italy, the U.K. and Spain.
According to the study, the researchers applied clinical criteria of systemic inflammatory response syndrome (SIRS), sepsis or septic shock to hospitalized patients with culture-confirmed E. coli from urine or a presumed sterile site and then they assessed a proposed clinical case definition against physician diagnoses.
Overall, of the 902 patients with IED included, 76.5% were adults aged 60 years and older, with 51.9%, 25.1% and 23% of cases being community acquired (CA), hospital acquired (HA) and health care associated (HCA), respectively.
At diagnosis, nearly all patients (96.8%) reported at least one symptom of IED, with the most common being fever (70.3%), nausea or vomiting (30.8%), chills (24.4%) and malaise (20.2%).
Among all included cases, SIRS was identified in 77.4%, sepsis in 65.3% and septic shock in 14.1%. The study demonstrated that the urinary tract was the most common source of infection (52.3%), followed by the GI tract for patients with hospital-acquired IED (32.7%).
The researchers noted that 77.8% of all patients initiated antibiotic use on the day of culture sample collection. Among the culture samples, 65.6% and 40.8% of E. coli isolates were resistant to one or more agent in one or more or two or more drug classes.
Additionally, the case fatality rate (CFR) was 20%, with 180 patients dying during the 28-day follow-up period. When broken down by age, CFR was 0% in patients younger than 18 years, 14.5% in those aged 18 to 59 years, 21.5% among adults aged 60 to 75 years and 22.2% among adults aged 75 years and older.
These rates reportedly increased across IED acquisition settings — 28.3% among HA infections, 21.7% among HCA infections and 15.2% among CA infections, and was 22.6% in men and 17.2% in women.
“Data reported here describing clinical characteristics stratified by infection acquisition setting, age, and infection outcome facilitate timely and accurate diagnosis of IED,” the representative told Healio. “Further, antimicrobial resistance data provide valuable information for those working to optimize therapeutic treatment and patient management.”
They added that these data add to the growing body of evidence “that highlights the burden and important unmet medical need presented by extraintestinal pathogenic E. coli causing invasive E. coli disease.”
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