Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study

Abstract

Background Escherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each. Methods During 2014–2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014–2018), region (five areas), age (< 70-years-old, ≥70-years-old), sex (female, male), third-generation cephalosporin (3GC) resistance (susceptible, resistant), and location of onset (community-onset, hospital-onset). The European Union 28-country 2018 population was used to directly age and sex standardize mortality rates. We used a multivariable Poisson model to estimate factors associated with mortality rate, and year, region, age and sex were considered for inclusion. Results From 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those < 70-years-old or female. Conclusions In our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk.

Epidemiology and Pattern of Resistance of Gram-Negative Bacteria Isolated from Blood Samples in Hospitalized Patients: A Single Center Retrospective Analysis from Southern Italy

“…The survival analysis of our study of the hospital mortality rate showed that the hospital E. coli bacteremia mortality was lower than bacteremia due to other strains. This follows a recent review where the case fatality rate for in-hospital E. coli bacteremia did not differ appreciably from that in the general population [30].…”

Achromobacter Species: An Emerging Cause of Community-Onset Bloodstream Infections

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Plant-derived nanoparticles as alternative therapy against Diarrheal pathogens in the era of antimicrobial resistance: A review

“…The Diarrhea cause by antibiotic-resistant pathogens can lead to severe illnesses, extended hospital stays, increase in healthcare costs, socio-economic burden as well as treatment failures (Rahim et al, 2021). The death rate in humans resulting from complications caused by resistant Diarrheagenic bacteria has increased globally (Vos et al, 2020;Mac Kinnon et al, 2021). In 2019, the global death caused by notable Diarrheagenic bacteria such as E. coli, V. cholerae, Shigella, Salmonella, Campylobacter, and Clostridium species were 60,414, 117,240, 148,202, 61,646, 139,079, and 32,134, respectively (IHME, 2020).…”