Summary
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.
Keywords
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Article info
Publication history
Published online: November 04, 2018
Accepted:
October 30,
2018
Received:
September 7,
2018
Identification
Copyright
© 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
