Population-based incidence and comparative demographics of community-associated and healthcare-associated Escherichia coli bloodstream infection in Auckland, New Zealand, 2005 – 2011

Abstract

BackgroundEscherichia coli is a major human pathogen, both in community and healthcare settings. To date however, relatively few studies have defined the population burden of E. coli bloodstream infections. Such information is important in informing strategies around treatment and prevention of these serious infections. Against this background, we performed a retrospective, population-based observational study of all cases of E. coli bacteremia in patients presenting to our hospital between January 2005 and December 2011.MethodsAuckland District Health Board is a tertiary-level, university-affiliated institution serving a population of approximately 500,000, within a larger metropolitan population of 1.4 million. We identified all patients with an episode of bloodstream infection due to E. coli over the study period. A unique episode was defined as the first positive E. coli blood culture taken from the same patient within a thirty-day period. Standard definitions were used to classify episodes into community- or healthcare-associated E. coli bacteremia. Demographic information was obtained for all patients, including: age; gender; ethnicity; length of stay (days); requirement for intensive care admission and all-cause, in-patient mortality.ResultsA total of 1507 patients had a unique episode of E. coli bacteremia over the study period. The overall average annual incidence of E. coli bacteremia was 52 per 100,000 population, and was highest in the under one year and over 65-year age groups. When stratified by ethnicity, rates were highest in Pacific Peoples and Māori (83 and 62 per 100,000 population respectively). The incidence of community-onset E. coli bacteremia increased significantly over the study period. The overall in-hospital mortality rate was 9% (135/1507), and was significantly higher in patients who had a hospital-onset E. coli bacteremia.ConclusionsOur work provides valuable baseline data on the incidence of E. coli bacteremia in our locale. The incidence was higher that that described from other developed countries, with significant demographic variation, most notably in ethnic-specific incidence rates. Future work should assess the possible reasons for this disparity.

Thirty day all-cause mortality in patients with Escherichia coli bacteraemia in England

“…In contrast, a Finnish population study reported mortality in E. coli bacteraemia patients of only 8% [17]. A large Canadian study [18] reported a case fatality rate of 11% for hospital inpatients with E. coli bacteraemia whereas in Auckland, New Zealand, the inpatient mortality rate was estimated at 9% [19]. We report here the use of English mandatory surveillance data linked to death registrations to determine 30-day all-cause mortality among a large nationwide data set of patients with E. coli bacteraemia.…”

Prevalence and multidrug resistance of Escherichia coli from community-acquired infections in Lagos, Nigeria

“…Many of the resistances in MDR E. coli are located on plasmids, which increases the possibility of clonal dissemination of these resistance classes in the community [18][19][20][21]. Spread of MDR E. coli globally can also be attributed to clones, such as E. coli sequence type 131 (ST131), known for its resistance to fluoroquinolones, aminoglycosides and trimethoprimsulfamethoxazole, as well as its virulence and propensity to exchange genetic material, characteristics which further complicate therapy.…”

Population-Based Epidemiology and Microbiology of Community-Onset Bloodstream Infections

“…However, since the turn of the millennium, these have emerged as major communityonset pathogens worldwide (207,212). Series of community-onset BSIs due to a range of ESBL-producing Enterobacteriaceae have been reported from around the globe (13,81,(213)(214)(215)(216). Molecular epidemiology studies have identified a globally distributed clone, ST131, and defined the importance of international travel in the acquisition and spread of these infections (217)(218)(219)(220)(221)(222).…”