1820. Clinical Characteristics of Invasive Extraintestinal Pathogenic Escherichia coli Disease Among Older Adult Patients Treated in Hospitals in the United States. (15th December 2022)

• Record Type: Journal Article
• Authors: Saade, Elie; Geurtsen, Jeroen; Baugh, Bryan; Khoury, Antoine El; Kalu, Nnanya; Gauthier-Loiselle, Marjolaine; Bungay, Rebecca; Cloutier, Martin; Pastor, Luis Hernandez
• Is Part Of: Open forum infectious diseases. Volume 9:(2022)Supplement 2
• Publication Date: 2022-12-15
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac492.1450
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: The risk of invasive extraintestinal pathogenic Escherichia coli disease (IED) increases with age and can lead to severe outcomes, including sepsis and death. Aim: To describe the clinical outcomes of IED in older adults in the United States (US). Methods: The Premier Healthcare Database (10/01/2015-03/31/2020) was used to identify IED encounters among patients ≥ 60 years old. The index encounter was defined as the first encounter with a positive E. coli culture in a normally sterile body site (Group 1) or a positive E. coli culture in urine with signs of sepsis (Group 2), in the absence of other pathogens. Outcomes included medical resource utilization, antibiotic use, IED recurrence, and in-hospital death, and were descriptively reported during the index encounter and over the subsequent year. Results: Overall, 19, 773 patients with IED were included (mean age: 76.8 years; 67.4% female; 82.1% white). Approximately half of index encounters were from Group 1 (51.8%), and the vast majority of patients had community-onset IED (94.3%). Most index encounters led to inpatient hospitalization (96.5%; mean duration: 6.9 days) and 32.4% required transfer to an intensive care unit (mean duration: 3.7 days). During the index encounter, patients received a mean [SD] of 2.9 [1.4] antibiotic agents, and 30.1% received ≥ 4 agents. The 3 most prevalent antibiotics received were ceftriaxone (66.2%), vancomycin (36.3%), and piperacillin (35.0%; Fig 1 ). The majority of E. coli isolates showed resistance to ≥ 1 antibiotic category (61.7%), and 34.4% were classified as multi-drug resistant (i.e., ≥ 3 categories). Following discharge, 34.8% of patients were transferred to a skilled nursing/intermediate care facility. In-hospital death reached 6.8% during the index encounter and increased to 10.9% 1-year post-index (Fig 2 ). One-year post-index, 2.4% of patients had an IED recurrence and 36.8% were readmitted to the hospital for any reason (Fig 3 ). Conclusion: Our findings suggest that IED is a severe disease that is associated with substantial burden and far-reaching consequences beyond the initial encounter. These findings emphasize the need for increased awareness and surveillance of IED and its consequences and the potential benefit of preventative measures. Disclosures: Elie Saade, MD, Janssen: Grant/Research Support|Pfizer: Board Member|Pfizer: Grant/Research Support|Sanofi Pasteur: Grant/Research Support|Sanofi Pasteur: Speaking/lecture fees, travel reimbursement|Seqirus: Grant/Research Support Jeroen Geurtsen, PhD, Janssen: Employee of Janssen Vaccines & Prevention BV Bryan Baugh, MD, Janssen Research & Development LLC: Employee|Janssen Research & Development LLC: Stocks/Bonds Antoine El Khoury, PhD, Janssen: Employee of Janssen Global Services, LLC. Nnanya Kalu, PhD, Janssen: Employee of Janssen Scientific Affairs, LLC. Marjolaine Gauthier-Loiselle, PhD, Janssen: Advisor/Consultant|Janssen: Advisor/Consultant Rebecca Bungay, MScPH, Janssen: Employees of Analysis Group, Inc. which has received consultancy fees from Janssen Scientific Affairs, LLC for the conduct of this studies. Martin Cloutier, MSc, Janssen: Employees of Analysis Group, Inc. which has received consultancy fees from Janssen Scientific Affairs, LLC for the conduct of this studies. Luis Hernandez Pastor, PharmD, PhD, Janssen: Employee of Janssen Pharmaceutica NV.