A multicenter, retrospective cohort study evaluated 13,165 adult patients (aged ≥18 years), of whom 1247 were admitted to 140 US hospitals with pneumonia and/or sepsis from 2010 to 2015 (included in the Premier Research database) due to Escherichia coli community-acquired bacterial pneumonia (E-CAP). Patients were included if they had community-onset infection and antibiotic treatment beginning within the first 2 hospital days and continued for at least 3 consecutive days. Patients were excluded if they had been transferred from another acute care facility, had cystic fibrosis, had a hospital length of stay of ≤1 days, had coexistent urinary tract infection, had gastrointestinal/intra-abdominal infection, or had simultaneous presence of other CAP pathogens. Pneumonia and sepsis were identified by International Classification of Diseases, 9th Revision codes. The majority of E-CAP patients were non–nursing home patients (90.2%, 1125/1247).
Of patients with E-CAP, 69.3% (864/1247) presented with sepsis syndrome compared with 48.1% in the other Gram-negative CAP group and 62.5% in the pneumococcal CAP (P-CAP) group. Aspiration pneumonia was diagnosed in 5.9%; blood cultures were positive in 59.9% with E-CAP, with 84.8% positivity in patients with sepsis syndrome. Patients with E-CAP were more likely to require intensive care (42.6% vs 38.2%), mechanical ventilation (19.3% vs 15.7%), and vasopressors (21% vs 13.8%). In-hospital mortality for patients with E-CAP was 14.8% compared with 7.4% in patients with P-CAP, and the median cost of hospitalization was higher in E-CAP ($12,420) versus P-CAP ($9857.50). Readmission within 30 days was greater among patients with E-CAP (5.4%) than with P-CAP (4.0%). Of isolates, 36.8% were resistant to fluoroquinolones, 10.4% to ceftriaxone, and 18.1% to aminoglycosides. Only 0.8% (10/1247) were multidrug resistant.
E coli is an important cause of severe CAP, requiring a higher acuity of care, and resulting in higher readmission rates and mortality than for patients with P-CAP. In addition, the rate of fluoroquinolone resistance is high in E-CAP, and irrespective of safety considerations, fluoroquinolone should be used empirically with caution in patients who are critically ill due to E-CAP.
Source: John TM, et al. IDWeek 2018. Abstract 1457.