O Blandy1, K Honeyford1, M Gharbi1, A Thomas1, F Ramzan1, M J Ellington2, R Hope2, A H Holmes1, A P Johnson3, P Aylin4, N Woodford3, S Sriskandan5. 1. NIHR Health Protection Research Unit for Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College, London, UK. 2. National Infection Service, Public Health England, UK. 3. NIHR Health Protection Research Unit for Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College, London, UK; National Infection Service, Public Health England, UK. 4. NIHR Health Protection Research Unit for Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College, London, UK; Department of Primary Care and Public Health, Imperial College, London, UK. 5. NIHR Health Protection Research Unit for Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College, London, UK. Electronic address: s.sriskandan@imperial.ac.uk.
Abstract
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.
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.
Authors: Tim M J Ewoldt; Alan Abdulla; Nicole G M Hunfeld; Anouk E Muller; Diederik Gommers; Suzanne Polinder; Birgit C P Koch; Henrik Endeman Journal: Ther Drug Monit Date: 2022-02-01 Impact factor: 3.118
Authors: Yu Wan; Ewurabena Mills; Rhoda C Y Leung; Ana Vieira; Xiangyun Zhi; Nicholas J Croucher; Neil Woodford; Elita Jauneikaite; Matthew J Ellington; Shiranee Sriskandan Journal: Microb Genom Date: 2021-12
Authors: Ann Sarah Walker; Nicole Stoesser; Samuel Lipworth; Karina-Doris Vihta; Kevin Chau; Leanne Barker; Sophie George; James Kavanagh; Timothy Davies; Alison Vaughan; Monique Andersson; Katie Jeffery; Sarah Oakley; Marcus Morgan; Susan Hopkins; Timothy E A Peto; Derrick W Crook Journal: Genome Med Date: 2021-09-03 Impact factor: 15.266
Authors: Elita Jauneikaite; Kate Honeyford; Oliver Blandy; Mia Mosavie; Max Pearson; Farzan A Ramzan; Matthew J Ellington; Julian Parkhill; Céire E Costelloe; Neil Woodford; Shiranee Sriskandan Journal: J Antimicrob Chemother Date: 2022-05-29 Impact factor: 5.758
Authors: Melissa C MacKinnon; Scott A McEwen; David L Pearl; Outi Lyytikäinen; Gunnar Jacobsson; Peter Collignon; Daniel B Gregson; Louis Valiquette; Kevin B Laupland Journal: BMC Infect Dis Date: 2021-06-25 Impact factor: 3.090