Abstract
BackgroundEscherichia coli is one of the most common strains of extended-spectrum β-lactam (ESBL)-producing bacteria, and the prevention and treatment of ESBL-producing E. coli infections is an ongoing challenge. The clinical characteristics and outcomes of ESBL-producing E. coli bacteremia in non-transplant patients remain to be elucidated.MethodsThis retrospective study included 491 non-transplant patients with E. coli bloodstream infections (BSIs) from January 2013 to December 2016 and was conducted to investigate the risk factors, clinical features, and outcomes of these infections.ResultsOf the 491 E. coli BSI patients, 57.6% suffered from infections with ESBL-producing strains. A multivariate analysis showed that urinary tract infection, prior use of cephalosporin, and treatment with β-lactam-β-lactamase inhibitor (BLBLI) combination antibiotics were independent risk factors for the development of ESBL-producing E. coli BSIs. The overall mortality rate in E. coli BSI patients was 14.46%, and there was no significant difference in the 28 day mortality rate between ESBL-producing E. coli and non-ESBL-producing E. coli BSI patients (14.8% vs. 14.0%, respectively; P = 0.953). Similarly, there was no difference between the community-acquired infection group and the nosocomial infection group. Hepatobiliary disease, carbapenem exposure, high APACHE II score, and hypoproteinemia were independent risk factors for death in E. coli BSI patients. Multivariate analysis showed that hypoproteinemia and severe disease were independent risk factors for death from ESBL-producing E. coli BSIs. Furthermore, there was no significant difference in the 28 day mortality between patients with ESBL-producing E. coli BSIs treated with carbapenem monotherapy versus those treated with BLBLI combination antibiotics (12.8% vs. 17.9%, respectively; P = 0.384).ConclusionsPrior use of cephalosporin or BLBLI combination antibiotics increased the risk ratio for ESBL-producing E. coli infection. Hypoproteinemia and severe disease are independent risk factors for death in patients with E. coli BSIs. There was no significant difference in the 28 day prognosis of patients with ESBL-producing E. coli and those with non-ESBL-producing E. coli BSIs. These data do not support the conclusion that carbapenems might be more effective than BLBLI antibiotics for treatment of patients with BSIs caused by ESBL-producing E. coli.
Highlights
Escherichia coli is one of the most common strains of extended-spectrum β-lactam (ESBL)-producing bacteria, and the prevention and treatment of Extended-spectrum beta-lactamase (ESBL)-producing E. coli infections is an ongoing challenge
Clinical characteristics From January 2013 to December 2016, 491 patients with E. coli Bloodstream infection (BSI) were included in this study, except for 67 patients who received solid organ or hematopoietic stem cell transplants and 22 patients with carbapenem-resistant Enterobacteriaceae (CRE) BSIs
Logistic regression analysis showed that urinary tract infections were the primary site of E. coli BSIs (OR = 1.897, P = 0.014) and that cephalosporin exposure (OR = 2.767, P = 0.007) and treatment with β-lactam-βlactamase inhibitor combination antibiotics (BLBLI) combination regimens in the 30 days prior to the BSI (OR = 1.950, P = 0.010) were independent risk factors for ESBL-producing E. coli BSIs
Summary
Escherichia coli is one of the most common strains of extended-spectrum β-lactam (ESBL)-producing bacteria, and the prevention and treatment of ESBL-producing E. coli infections is an ongoing challenge. Escherichia coli is one of the most common strains of extended-spectrum β-lactamase (ESBL)-producing bacteria [1]. In the past 10 years, the detection rate of ESBL-producing E. coli has continued to increase dramatically worldwide. In Asia, and in China, the prevalence rate is much higher than that in Western developed countries [3, 4]. The production of β-lactamase enzymes is the principal mechanism by which Gram-negative bacteria resist the action of β-lactam antibiotics. According to relevant domestic monitoring data, E. coli accounted for the largest proportion of resistant bacteria detected in China, followed by K. pneumoniae [5]
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