Mortality and length of hospital stay after bloodstream infections caused by ESBL-producing compared to non-ESBL-producing E. coli

Figures & data

Table 1. Demographic and clinical characteristics of patients with E. coli blood stream infections.

	ESBL-E. coli (N*=234)		Non-ESBL-E. coli (N*=234)
	N	%	N	%	p
Median age (IQR), years	72 (60-80)		72 (64-80)		0.251
Sex, female	112	47.9%	108	46.2%	0.711
Type of infection
Community acquired	72	30.8%	112	48.5%	<0.001
Healthcare-associated	126	53.9%	88	38.1%	0.001
Hospital acquired	36	15.4%	31	13.4%	0.546
Admitted from
Home	186	79.5%	215	91.9%	<0.001
Healthcare institutions	37	15.8%	17	7.3%	0.004
Other hospitals	11	4.7%	2	0.9%	0.021
Department requesting the blood culture
Emergency department	173	73.9%	172	73.5%
ICU	15	6.4%	11	4.7%	0.420
Other wards	46	19.7%	51	21.8%
Charlson Comorbidity Index
≤2	120	51.3%	128	54.7%	0.459
>2	114	48.7%	106	45.3%
Source of infection**
Urinary tract	171	73.1%	146	62.4%	0.013
Biliary tract	24	10.3%	32	13.7%	0.255
Intra-abdominal	13	5.6%	18	7.7%	0.353
Neutropenic fever	5	2.1%	12	5.1%	0.084
Other***	13	5.6%	21	9%	0.154
Unknown/Not determined	17	7.3%	18	7.7%	0.861
qSOFA	N = 217		N = 212
0-1	148	68.2%	148	69.8%	0.719
2-3	69	31.8%	64	30.2%
Septic shock	N = 217		N = 215
Yes	8	3.7%	7	3.3%	0.807
Neutropenia	N = 233		N = 232
Yes	5	2.2%	13	5.6%	0.053
Presence of an invasive device >24 hours	N = 232		N = 230
Yes	65	28 %	45	19.6%	0.033
Type of invasive device**	N = 232		N = 230
Urinary catheter	52	22.4%	32	13.9%	0.018
Central venous catheter	15	6.5%	14	6.1%	0.867
Other	6	2.6%	4	1.7%	0.751
Antibiotic therapy previous six months	N = 220		N = 231
Yes	137	62.3%	78	33.8%	<0.001
Hospital admission abroad	N = 222		N = 233
Yes	13	5.9%	1	0.4%	0.001
History of ESBL-producing microbe
Yes	93	39.7%	2	0.9%	<0.001
Readmission within 30 days of discharge	N = 205		N = 219
Yes	61	29.8%	60	27.4%	0.591

* Total N = 234 for all variables unless otherwise indicated.

** More than one possible option.

*** Includes pulmonary, gynaecological, skin and soft tissue and other origins.

Figure 1. Thirty-day survival in ESBL-producing E. coli compared to non-ESBL-producing E. coli blood stream infections.

Table 2. All-cause mortality for patients with ESBL-producing E. coli compared to non-ESBL-producing E. coli bloodstream infections.

	ESBL-E. coli (N = 230)		Non-ESBL-E. coli (N = 234)
	N	%	N	%	p
0-26 hours	7	3 %	7	3 %	0.974
30 days	25	10.9%	21	9 %	0.495
60 days	37	16.1%	32	13.7%	0.466
90 days	45	19.6%	38	16.2%	0.351
1 year (only 2014-2020)	N = 202		N = 206
1 year mortality	58	28.7%	55	26.7%	0.650

Figure 2. Time to administration of the first dose of effective antibiotic in ESBL-producing E. coli compared to non-ESBL-producing E. coli blood stream infections.

Figure 3. Length of stay of ESBL-producing E. coli compared to non-ESBL-producing E. coli blood stream infections according to source of infection.

Table

	ESBL-E. coli (N*=234)		Non-ESBL-E. coli (N*=234)
	N	%	N	%	p
Comorbidities**
Myocardial infarction	36	15.4%	33	14.1%	0.696
Congestive heart failure	20	8.6%	17	7.3%	0.607
Peripheral vascular disease	23	9.8%	20	8.6%	0.631
Cerebrovascular disease	37	15.8%	34	14.5%	0.699
Dementia	11	4.7%	10	4.3%	0.823
Chronic pulmonary disease	48	20.5%	43	18.4%	0.559
Connective tissue disease	21	9 %	11	4.7%	0.067
Ulcer disease	7	3 %	13	5.6%	0.170
Mild liver disease	16	6.8%	5	2.1%	0.014
Moderate/severe liver disease	7	3 %	3	1.3%	0.338
Diabetes mellitus without complications	59	25.2%	44	18.8%	0.094
Diabetes mellitus with complications	18	7.7%	10	4.3%	0.119
Hemi-/Paraplegia	10	4.3%	5	2.1%	0.189
Chronic renal disease	45	19.2%	43	18.4%	0.813
Non-metastatic cancer	48	20.5%	51	21.8%	0.734
Metastatic cancer	19	8.1%	29	12.4%	0.128
Leukaemia	6	2.6%	9	3.9%	0.431
Lymphoma	8	3.4%	10	4.3%	0.631
HIV/AIDS	0	–	0	–
Immunosuppressive therapy	N = 231		N = 230
Yes	62	26.8%	63	27.4%	0.894
Organ or haematopoietic stem cell transplantation
Yes	18	7.7%	14	6%	0.464
Dialysis previous 12 months	N = 232		N = 234
Yes	10	4.3%	4	1.7%	0.112
Surgery or invasive procedure previous 30 days	N = 230		N = 229
Yes	71	30.9%	58	25.3%	0.187

* Total N = 234 for all variables unless otherwise indicated.

** More than one possible option.

Table

	Deceased (N*=46)		Alive (N*=418)		Unadjusted OR
	N	%	N	%	(95% CI)	p
Median age (IQR), years	75 (64-81)		72 (61-80)		-	0.140
Sex, female	26	56.5%	190	45.5%	1.6 (0.8 − 2.9)	0.154
ESBL-producing E. coli BSI	25	54.4%	205	49 %	1.2 (0.7 − 2.3)	0.495
Charlson Comorbidity Index ≤2	10	21.7%	234	56 %	Base
Charlson Comorbidity Index >2	36	78.3%	184	44 %	4.6 (2.2 − 9.6)	<0.001
Type of infection	N = 46		N = 415
Community acquired	6	13 %	175	42.2%	Base
Health care associated	26	56.5%	188	45.3%	4 (1.6 - 10)	0.003
Hospital acquired	14	30.4%	52	12.5%	7.9 (2.9 − 21.5)	<0.001
Source of infection**
Urinary tract	15	32.6%	299	71.5%	0.2 (0.1 − 0.4)	<0.001
Biliary tract	1	2.2%	54	12.9%	0.1 (0 − 1.1)	0.033
Intra-abdominal	8	17.4%	23	5.5%	3.6 (1.5 − 8.7)	0.002
Neutropenic fever	4	8.7%	13	3.1%	3 (0.9 − 9.6)	0.056
Other	7	15.2%	27	6.5%	2.6 (1.1 − 6.4)	0.031
Unknown/Not determined	15	32.6%	20	4.8%	9.6 (4.3 − 21.5)	<0.001
qSOFA	N = 40		N = 385
0-1	16	40 %	276	71.7%	Base
2-3	24	60 %	109	28.3%	3.8 (1.9 − 7.5)	<0.001
Septic shock	N = 34		N = 394
Yes	7	20.6%	8	2%	12.5 (4 − 38.8)	<0.001
Neutropenia	N = 44		N = 417
Yes	4	9.1%	14	3.4%	2.9 (0.9 − 9.2)	0.062
Immunosuppressive therapy	N = 44		N = 413
Yes	15	34.1%	110	26.6%	1.4 (0.7 to 2.8)	0.292
Surgery/invasive procedure previous 30 days	N = 45		N = 410
Yes	17	37.8%	112	27.3%	1.6 (0.8 to 3.1)	0.140
Time to administration of first effective antibiotic	N = 45		N = 393
0 − 3 hours	26	57.8%	213	54.2%	Base
>3 - 12 hours	3	6.7%	44	11.2%	0.6 (0.2 − 1.9)	0.357
>12 - 24 hours	6	13.3%	37	9.4%	1.3 (0.5 − 3.4)	0.559
>24 - 48 hours	0	–	71	18.1%	–
>48 − 72 hours	3	6.7%	13	3.3%	1.9 (0.5 - 7)	0.344
>72 hours	1	2.2%	8	2 %	1 (0.1 − 8.5)	0.982
No effective treatment	6	13.3%	7	1.8%	7 (2.2 − 22.5)	0.001

* =Total N unless otherwise indicated.

** More than one possible option.

Table

	ESBL-E. coli (N = 234)			Non-ESBL - E. coli (N = 234)
All BSIs	N	% of N	Cum. %	N	% of N	Cum. %
0-3 hours	80	34.2%	34.2%	162	69.2%	69.2%
>3-12 hours	21	9 %	43.2%	26	11.1%	80.3%
>12-24 hours	28	12 %	55.2%	15	6.4%	86.7%
>24 − 48 hours	63	26.9%	82.1%	9	3.9%	90.6%
>48 − 72 hours	16	6.8%	88.9%	0	–	90.6%
> 72 hours	8	3.4%	92.3%	1	0.4%	91 %
No effective antibiotic	9	3.9%	96.2%	4	1.7%	92.7%
	History of ESBL (N = 93)			No history of ESBL (N = 141)
Only ESBL-EC BSIs	N	% of N	Cum. %	N	% of N	Cum. %
0-3 hours	39	41.9%	41.9%	41	29.1%	29.1%
>3-12 hours	11	11.8%	53.7%	10	7.1%	36.2%
>12-24 hours	15	16.1%	69.8%	13	9.2%	45.4%
>24 − 48 hours	16	17.2%	87 %	47	33.3%	78.7%
>48 − 72 hours	4	4.3%	91.3%	12	8.5%	87.2%
> 72 hours	3	3.2%	94.5%	5	3.6%	90.8%
No effective antibiotic	4	4.3%	98.8%	5	3.6%	94.4%

Table

	ESBL - E. coli (N = 234)		Non-ESBL- E. coli (N = 234)
Antibiotic	N	% resistant	N	% resistant
Trimethoprim-sulfamethoxazole	165	70.5%	43	18.4%
Ciprofloxacin	174	74.4%	19	8.1%
Ampicillin iv	234	100 %	76	32.5%
Cefuroxime iv	234	100 %	5	2.1%
Cefotaxime	234	100 %	0	–
Ceftazidime	205	87.6%	0	–
Gentamicin	114	48.7%	6	2.6%
Meropenem	0	–	0	–
Piperacillin-tazobactam	11	4.7%	2	0.9%
Aztreonam	198	84.6%	0	–

Resistance determined according to EUCAST breakpoint tables at the time of reporting.