An analysis of invasive extraintestinal pathogenic Escherichia coli disease (IED) in older patients found a substantial clinical burden, with considerable long-term consequences, researchers reported yesterday in BMC Infectious Diseases.
To describe and characterize the short- and long-term impacts of IED, which comprises sepsis, bacteremia, peritonitis, meningitis, and other infectious syndromes, researchers from Europe, Canada, and the United States analyzed data on patients aged 60 and older with either a positive E coli culture and one or more signs of sepsis or a positive E coli culture in urine with urinary tract infection and signs of sepsis. The primary outcomes analyzed were clinical outcomes, medical resource use, and E coli isolate characteristics.
A third of patients admitted to ICU
Overall, 19,773 patients with IED from October 2015 through March 2020 were included (mean age, 76.8 years; 67.4% female; 78.5% with signs of sepsis). The vast majority of encounters involved community-onset IED (94.3%) and required hospitalization (96.5%; mean duration, 6.9 days), with 32.4% of patients being admitted to the intensive care unit (mean duration, 3.7 days) and 8.6% requiring mechanical ventilation. Nearly all patients (99.3%) were treated with antibiotics and typically received several antibiotic courses.
Nearly two thirds (61.7%) of E coli isolates were resistant to one or more antibiotic category, and 34.4% were resistant to three or more antibiotic categories. Following their first IED encounter, 34.8% of patients were transferred to a skilled nursing/intermediate care facility, and 6.8% had died. During the 12-month observation period, 36.8% of IED patients were re-hospitalized, 2.4% had IED recurrence, and in-hospital death increased to 10.9%.
This burden is particularly high in the presence of antibiotic resistance.
The study authors say the findings are important given the global increase in E coli infections and rising rates of antibiotic resistance.
"The findings suggest that IED is associated with an acute burden during the initial hospital encounter and may lead to poor outcomes even after the encounter is resolved," the study authors wrote. "This burden is particularly high in the presence of antibiotic resistance, which is an important consideration for an increasing aging population."