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Characterization of Bacteremic and Non-Bacteremic Syndromesof invasive escherichia Coli disease among hospitalized adults aged ≥60 years: findings from a prospective, multinational, observatory study (EXPECT-2)

Doua J, Rodríguez-Baño J, Vallejo C, Puranam P, Go O, Geurtsen J, van Rooij S, Vilken T, Minoru I, Yasumori I, Spiessens B, Tacconelli E, Biehl L, Thaden J, Sarnecki M, Goossens H, Poolman J, Bonten M, Ekkelenkamp M

Intro: Published data is limited in describing clinical features and disease burden of invasive Escherichia coli disease (IED). This study characterized bacteremic and non-bacteremic IED in relation to clinical features and multidrug resistance (MDR) of causative E. coli isolates.

Methods: EXPECT-2 (NCT04117113) was a multinational, hospital-based, observational study that prospectively enrolled IED patients aged ≥60 years between October 2019 and January 2021. IED was defined by a positive E. coli culture from blood (bacteremic IED), a sterile body site or urine (non-bacteremic IED) in the presence of requisite criteria of Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), or quick SOFA (qSOFA). In-hospital mortality and IED-related medical encounters were assessed through 28 days following IED diagnosis. MDR was defined as acquired non-susceptibility to ≥1 antibiotic in ≥3 antimicrobial classes.

Findings: The full analysis set included 193 bacteremic (80.4%) and 47 non- bacteremic (19.6%) patients. Patient demographics were balanced between bacteremic and non-bacteremic IED. The rates of patients with ≥2 SIRS criteria were comparable between bacteremic (64.8%) and non-bacteremic IED (70.2%). The rates of patients with the ≥2-point change in total SOFA score were comparable between bacteremic (62.2%) and non-bacteremic IED (53.2%). The rates of sepsis and septic shock were 75.0% and 11.4%, respectively, for bacteremic, and 83.3% and 7.1%, respectively, for non-bacteremic IED. The most common IED-related medical encounter was the emergency room both in patients with bacteremic (31.5%, [41/130]) and non-bacteremic IED (35.9%, [14/39]). Of 11 patients who died, 6 (54.5%) had bacteremic IED. Of 294 E. coli isolates with antimicrobial susceptibility testing collected from 238 patients, MDR rates were 34.7% (87/251) for bacteremic and 37.2% (16/43) for non-bacteremic isolates.

Conclusion: IED manifested as severe infection, with approximately one-third of E. coli isolates displaying MDR. Bacteremic and non-bacteremic IED were characterized by similar clinical features and MDR phenotypes.

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