Clinical presentation and antimicrobial resistance of invasive Escherichia coli disease in hospitalized older adults: a prospective multinational observational study.
Antimicrobial resistance
Bacteremia
Bloodstream infection
Elderly
Extraintestinal pathogenic E. coli
Invasive E. coli disease
Sepsis
Journal
Infection
ISSN: 1439-0973
Titre abrégé: Infection
Pays: Germany
ID NLM: 0365307
Informations de publication
Date de publication:
25 Jan 2024
25 Jan 2024
Historique:
received:
16
08
2023
accepted:
18
12
2023
medline:
25
1
2024
pubmed:
25
1
2024
entrez:
24
1
2024
Statut:
aheadofprint
Résumé
Clinical data characterizing invasive Escherichia coli disease (IED) are limited. We assessed the clinical presentation of IED and antimicrobial resistance (AMR) patterns of causative E. coli isolates in older adults. EXPECT-2 (NCT04117113) was a prospective, observational, multinational, hospital-based study conducted in patients with IED aged ≥ 60 years. IED was determined by the microbiological confirmation of E. coli from blood; or by the microbiological confirmation of E. coli from urine or an otherwise sterile body site in the presence of requisite criteria of systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), or quick SOFA (qSOFA). The primary outcomes were the clinical presentation of IED and AMR rates of E. coli isolates to clinically relevant antibiotics. Complications and in-hospital mortality were assessed through 28 days following IED diagnosis. Of 240 enrolled patients, 80.4% had bacteremic and 19.6% had non-bacteremic IED. One-half of infections (50.4%) were community-acquired. The most common source of infection was the urinary tract (62.9%). Of 240 patients, 65.8% fulfilled ≥ 2 SIRS criteria, and 60.4% had a total SOFA score of ≥ 2. Investigator-diagnosed sepsis and septic shock were reported in 72.1% and 10.0% of patients, respectively. The most common complication was kidney dysfunction (12.9%). The overall in-hospital mortality was 4.6%. Of 299 E. coli isolates tested, the resistance rates were: 30.4% for trimethoprim-sulfamethoxazole, 24.1% for ciprofloxacin, 22.1% for levofloxacin, 16.4% for ceftriaxone, 5.7% for cefepime, and 4.3% for ceftazidime. The clinical profile of identified IED cases was characterized by high rates of sepsis. IED was associated with high rates of AMR to clinically relevant antibiotics. The identification of IED can be optimized by using a combination of clinical criteria (SIRS, SOFA, or qSOFA) and culture results.
Sections du résumé
BACKGROUND
BACKGROUND
Clinical data characterizing invasive Escherichia coli disease (IED) are limited. We assessed the clinical presentation of IED and antimicrobial resistance (AMR) patterns of causative E. coli isolates in older adults.
METHODS
METHODS
EXPECT-2 (NCT04117113) was a prospective, observational, multinational, hospital-based study conducted in patients with IED aged ≥ 60 years. IED was determined by the microbiological confirmation of E. coli from blood; or by the microbiological confirmation of E. coli from urine or an otherwise sterile body site in the presence of requisite criteria of systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), or quick SOFA (qSOFA). The primary outcomes were the clinical presentation of IED and AMR rates of E. coli isolates to clinically relevant antibiotics. Complications and in-hospital mortality were assessed through 28 days following IED diagnosis.
RESULTS
RESULTS
Of 240 enrolled patients, 80.4% had bacteremic and 19.6% had non-bacteremic IED. One-half of infections (50.4%) were community-acquired. The most common source of infection was the urinary tract (62.9%). Of 240 patients, 65.8% fulfilled ≥ 2 SIRS criteria, and 60.4% had a total SOFA score of ≥ 2. Investigator-diagnosed sepsis and septic shock were reported in 72.1% and 10.0% of patients, respectively. The most common complication was kidney dysfunction (12.9%). The overall in-hospital mortality was 4.6%. Of 299 E. coli isolates tested, the resistance rates were: 30.4% for trimethoprim-sulfamethoxazole, 24.1% for ciprofloxacin, 22.1% for levofloxacin, 16.4% for ceftriaxone, 5.7% for cefepime, and 4.3% for ceftazidime.
CONCLUSIONS
CONCLUSIONS
The clinical profile of identified IED cases was characterized by high rates of sepsis. IED was associated with high rates of AMR to clinically relevant antibiotics. The identification of IED can be optimized by using a combination of clinical criteria (SIRS, SOFA, or qSOFA) and culture results.
Identifiants
pubmed: 38267801
doi: 10.1007/s15010-023-02163-z
pii: 10.1007/s15010-023-02163-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Innovative Medicines Initiative Joint Undertaking
ID : 115523
Organisme : Innovative Medicines Initiative Joint Undertaking
ID : 115523
Organisme : Innovative Medicines Initiative Joint Undertaking
ID : 115523
Organisme : Innovative Medicines Initiative Joint Undertaking
ID : 115523
Organisme : Innovative Medicines Initiative Joint Undertaking
ID : 115523
Organisme : Innovative Medicines Initiative Joint Undertaking
ID : 115523
Organisme : Innovative Medicines Initiative Joint Undertaking
ID : 115523
Organisme : Innovative Medicines Initiative Joint Undertaking
ID : 115523
Organisme : Innovative Medicines Initiative Joint Undertaking
ID : 115523
Organisme : Innovative Medicines Initiative Joint Undertaking
ID : 115523
Investigateurs
Madison Violette
(M)
Sonal Munshi
(S)
Moussa Aitabi
(M)
Christine Lammens
(C)
Sofie Van Mieghem
(S)
Sandra Van Puyvelde
(S)
Basil Britto Xavier
(BB)
Anna Maria Azzini
(AM)
Elda Righi
(E)
Nicola Duccio Salerno
(ND)
Giuliana Lo
(G)
Cascio Eleonora Cremonini
(CE)
Álvaro Pascual
(Á)
Reinaldo Espíndola
(R)
Virginia Palomo
(V)
Sarah Walker
(S)
Felicia Ruffin
(F)
Michael Dagher
(M)
Andreja Varjačić
(A)
Informations de copyright
© 2024. The Author(s).
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