Impact of host-pathogen-treatment tripartite components on early mortality of patients with Escherichia coli bloodstream infection: Prospective observational studyResearch in context
Eun-Jeong Yoon,
Min Hyuk Choi,
Yoon Soo Park,
Hye Sun Lee,
Dokyun Kim,
Hyukmin Lee,
Kyeong Seob Shin,
Jong Hee Shin,
Young Uh,
Young Ah. Kim,
Jeong Hwan Shin,
Seok Hoon Jeong
Affiliations
Eun-Jeong Yoon
Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
Min Hyuk Choi
Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
Yoon Soo Park
Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
Hye Sun Lee
Biostatistics Collaboration Unit, College of Medicine, Yonsei University, Seoul, South Korea
Dokyun Kim
Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
Hyukmin Lee
Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
Kyeong Seob Shin
Department of Laboratory Medicine, College of Medicine, Chungbuk National University, Cheongju, South Korea
Jong Hee Shin
Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
Young Uh
Department of Laboratory Medicine, College of Medicine, Yonsei University Wonju, Wonju, South Korea
Young Ah. Kim
Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
Jeong Hwan Shin
Department of Laboratory Medicine, Paik Institute for Clinical Research, College of Medicine, Inje University, Busan, South Korea
Seok Hoon Jeong
Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea; Corresponding author at: Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 211 Eonju-ro, Seoul 06273, South Korea.
Background: Risk factors affecting early morality of patients with Escherichia coli bloodstream infection (BSI) were investigated including the host-pathogen-treatment tripartite components. Methods: Six general hospitals in South Korea participated in this multicentre prospective observational study from May 2016 to April 2017 and a total of 1492 laboratory-confirmed E. coli BSI cases were studied. Cox regression was used to estimate risks of the primary endpoint, i.e., all-cause mortality within 30 days from the initial blood culture. Six multivariate analysis models were constructed in accordance to the clinical importance and intra- and inter-component multicollinearity. Findings: Among the 1492 E. coli BSI cases, 9.5% (n = 141) patients expired within 30 days. Six models of multivariate analysis indicated risk factors of critical illness, primary infection of peritoneum, and chronic liver disease including cirrhosis for host variables; of phylogenetic group B2, ST131-sublineage H30Rx, multidrug resistance, group 1 CTX-M extended-spectrum beta-lactamase production, and having either of fyuA, afa, and sfa/foc virulence genes for causative E. coli pathogen variables; and of delayed definitive therapy for antimicrobial treatment variables. In addition, as a protective factor, primary urinary tract infection was identified. Interpretation: Despite decades' effort searching for the risk factors for E. coli BSI, systemic understanding covering the entire tripartite component is still lacking. This study detailed the organic impact of host-pathogen-treatment tripartite components for early mortality in patients with E. coli BSI. Keywords: Escherichia coli, Bloodstream infection, Early mortality, ST131, CTX-M ESBL, Delayed definitive treatment
