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

Abstract

Escherichia coli is the commonest cause of bacteraemia in England, with an incidence of 50.7 cases per 100 000 population in 2011. We undertook a large national study to estimate and identify risk factors for 30-day all-cause mortality in E. coli bacteraemia patients. Records for patients with E. coli bacteraemia reported to the English national mandatory surveillance system between 1 July 2011 and 30 June 2012 were linked to death registrations to determine 30-day all-cause mortality. A multivariable regression model was used to identify factors associated with 30-day all-cause mortality. There were 5220 deaths in 28 616 E. coli bacteraemia patients, a mortality rate of 18.2% (95% CI 17.8-18.7%). Three-quarters of deaths occurred within 14 days of specimen collection. Factors independently associated with increased mortality were: age < 1 year or > 44 years; an underlying respiratory or unknown infection focus; ciprofloxacin non-susceptibility; hospital-onset infection or not being admitted; and bacteraemia occurring in the winter. Female gender and a urogenital focus were associated with a reduction in mortality. This is the first national study of mortality among E. coli bacteraemia patients in England. Interventions to reduce mortality need to be multifaceted and include both primary and secondary healthcare providers. Greater awareness of the risk factors for and symptoms of E. coli bacteraemia may prompt earlier diagnosis and treatment. Changes in antimicrobial resistance patterns need to be monitored for their potential impact on infection and mortality.

Bacterial bloodstream infections in a tertiary infectious diseases hospital in Northern Vietnam: aetiology, drug resistance, and treatment outcome

“…The overall mortality in our study was slightly higher than the overall mortality of 22.5% in Cambodia where the epidemiology and pattern of resistance are similar [15]. We reported a high mortality of 35.6% among E. coli BSI, which is higher than mortality of 18.2% and 8% and in a large surveillance in England and in a population-based study in Finland [30, 31]. It is not clear about the reasons of the differences, but it may relate to pneumonia focus, severity of infection, antibiotic susceptibilities and seasonal variation [31].…”

“…We reported a high mortality of 35.6% among E. coli BSI, which is higher than mortality of 18.2% and 8% and in a large surveillance in England and in a population-based study in Finland [30, 31]. It is not clear about the reasons of the differences, but it may relate to pneumonia focus, severity of infection, antibiotic susceptibilities and seasonal variation [31]. As NHTD is a tertiary referral hospital, potentially more severe cases or cases that have failed therapy elsewhere may have been referred as compared to the hospitals included in other studies, leading to higher resistance and case fatality rates.…”

Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme

“…In 2015, 37,273 cases of E. coli bacteraemia were reported to the English mandatory surveillance programme 2 . Thirty-day all-cause mortality in England for this infection was recently estimated as 18.2% (17.8-18.7%), equating to 5,220 deaths over a 12-month period 3 . Thus appropriately targeted interventions are required to reduce morbidity and mortality associated with E. coli bacteraemia.…”

Descriptive epidemiology of Escherichia coli bacteraemia in England, April 2012 to March 2014

“…This is reinforced by studies from Austria, China and the United States, which have implicated E. coli as the first and second most common cause of community-acquired and hospital-acquired bloodstream infection (BSI) respectively [3-5]. A further study from England estimated the all-cause mortality rate in E. coli bacteraemia patients to be 18.2% between July 2011 and June 2012 [6]. In addition to a high mortality burden, E. coli bacteraemia has been associated with increases in length of hospital stay and difficulties with antibiotic treatment due to infections caused by resistant strains [2,7].…”