A Retrospective Analysis of Risk Factors and Patient Outcomes of Bloodstream Infection with Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Chinese Tertiary Hospital

Figures & data

Figure 1 Case identification flow chart.

Table 1 Antibiotic Resistance of ESBL-Producing Escherichia coli versus Non-ESBL-Producing Escherichia coli

Antimicrobial	Overall (n=980)	ESBL-Positive E. coli (n=563)	ESBL-Negative E. coli (n=417)	Χ^2	P value
Cefoxitin	17.5% (127/724)	17.0% (70/412)	18.3% (57/312)	0.201	0.654
Ciprofloxacin	52.9% (462/874)	70.5% (341/484)	31.0% (121/390)	134.745	<0.001
Levofloxacin	51.0% (499/978)	67.2% (377/561)	29.3% (122/417)	137.818	<0.001
Gentamicin	39.1% (382/977)	45.8% (257/561)	30.0% (125/416)	24.926	<0.001
Amikacin	2.5% (24/974)	3.6% (20/558)	1.0% (4/416)	6.821	0.09
Macrodantin	1.8% (16/891)	2.8% (14/496)	0.5% (2/395)	6.690	0.01
Tobramycin	11.1% (99/893)	15.3% (76/498)	5.8% (23/395)	19.907	<0.001
Meropenem	2.5% (2/81)	3.3% (2/61)	0(0/20)	-	0.565
Imipenem	1.6% (16/974)	1.2% (7/561)	2.2% (9/413)	1.277	0.258
Amoxicillin/clavulanate	16.1% (102/633)	13.1% (45/344)	19.7%(57/289)	5.125	0.024
Piperacillin/Tazobactam	3.1% (30/971)	1.6% (9/558)	5.1% (21/413)	9.510	0.002
Ampicillin/sulbactam	56.1% (143/255)	70.0% (105/150)	36.2% (38/105)	28.665	<0.001
Trimethoprim/sulfamethoxazole	51.1% (499/976)	56.9% (320/562)	43.2% (179/414)	17.914	<0.001

Table 2 Demographic and Clinical Characteristics of Patients with ESBL-Positive and ESBL-Negative Escherichia coli

Characteristics	ESBL Negative (n=408)	ESBL Positive (n=555)	Univariate Analysis		Multivariate Analysis
			P value	OR (95% CI)	P value	OR (95% CI)
Female	239	282	0.017	0.730 (0.564–0.945)	Not selected	Not selected
Median age (IQR)	61 (52–72)	61 (50–71)	0.317	0.996 (0.987–1.004)	-	-
Pre-existing medical conditions
Hypertension	139	181	0.636	0.937 (0.714–1.228)	-	-
Diabetes	85	88	0.047	0.716 (0.515–0.996)	Not selected	Not selected
Biliary tract infection	100	194	0.001	1.655 (1.244–2.201)	<0.001	1.798 (1.334–2.425)
Pancreatitis	17	17	0.363	0.728 (0.367–1.443)	-	-
Liver disease	56	79	0.822	1.043 (0.721–1.509)	-	-
Gastrointestinal disease	41	55	0.943	0.985 (0.643–1.508)	-	-
Urinary tract obstructive disease	37	83	0.007	1.763 (1.169–2.658)	0.001	2.106 (1.366–3.248)
Chronic kidney disease	26	35	0.967	0.989 (0.585–1.671)	-	-
Leukemia	17	13	0.112	0.552 (0.265–1.149)
Solid tumor	104	124	0.256	0.841 (0.624–1.134)	-	-
Invasive procedure or device
Central venous catheterization	49	80	0.280	1.234 (0.843–1.806)	-	-
Urinary catheterization	59	101	0.124	1.316 (0.927–1.868)	-	-
Gastrointestinal catheterization	18	47	0.015	2.005 (1.146–3.506)	Not selected	Not selected
Surgery within 3 months	100	190	0.001	1.603 (1.205–2.134)	0.002	1.591 (1.178–2.147)
Hospitalization within 3 months	138	278	<0.001	1.964 (1.508–2.557)	<0.001	2.075 (1.579–2.725)
Nosocomial infection	193	288	0.160	1.202 (0.930–1.552)	-	-
ICU admission	43	91	0.010	1.665 (1.130–2.453)	0.011	1.684 (1.124–2.522)
Antimicrobial exposure within 30 days
Penicillin	9	12	0.963	0.980 (0.409–2.348)	-	-
Cephalosporin	8	36	0.002	3.468 (1.594–7.544)	0.006	3.097 (1.392–6.891)
BLICs	31	67	0.024	1.670 (1.068–2.609)	Not selected	Not selected
Fluoroquinolone	19	33	0.383	1.294 (0.725–2.311)	-	-
Carbapenem	6	11	0.553	1.355 (0.497–3.694)	-	-

Table 3 Analysis of Risk Factors for 30-Day Mortality in Patients with Escherichia coli Bloodstream Infections

Characteristics	Survival (n=795)	Nonsurvival (n=79)	Multivariate Analysis
			P value	OR (95% CI)
aCCI score>2	623	71	0.016	2.453 (1.179–5.103)
ESBL-producing E. coli	463	45	0.671	Not selected
Central venous catheterization	101	13	0.719	Not selected
Urinary catheterization	120	21	0.070	Not selected
Gastrointestinal catheterization	47	11	0.004	2.525 (1.333–4.782)
Nosocomial infection	391	41	0.846	Not selected
Appropriate empirical antibiotic therapy	715	72	0.840	Not selected

Figure 2 Kaplan–Meier 30-day survival estimates: (A) patients (SOFA score <2) treat with carbapenem and BLICs antibiotics (p=0.008); (B) patients (SOFA score≥2) treated with carbapenem and noncarbapenem antibiotics (p=0.044).

Table 4 The Patients Treated with Single Regimens in Different SOFA Score Groups

SOFA Score	Total	Received BLICs		Received Carbapenems
		Survival	Nonsurvival	Survival	Nonsurvival
<2	85	98.5%(64/65)	1.5%(1/65)	90%(18/20)	10%(2/20)
2–6	135	95.2%(99/104)	4.8%(5/104)	96.8%(30/31)	3.2%(1/31)
7–9	43	90%(27/30)	10%(3/30)	76.9%(10/13)	23.1%(3/13)
≥10	31	86.7%(13/15)	13.3%(2/15)	62.5%(10/16)	37.5%(6/16)