Invasive E coli Infections Cause Significant Burden on US Healthcare Systems

Photo shows a sensitivity testing of bacteria using the disc diffusion technique.
Study authors conducted a retrospective, observational study to assess the prevalence and risk of recurrence of extraintestinal invasive E coli infections in the United States.

A substantial healthcare burden exists due to extraintestinal invasive Escherichia coli infectious (IEI) at hospitals in the United States, according to published in Clinical Infectious Diseases.

Data from the Premier Healthcare Solutions database, which contains details of a quarter hospital visits in the United States, were analyzed for this retrospective, observational study. Patients (N=37,207,510) who visited a hospital between 2009 and 2016 were assessed for IEI and evidence of antibiotic resistance.

These patients visited 236 hospitals on 144,944,725 occasions. IEI was found during 71,909 visits (0.19%) among 67,583 patients (0.18%).

At baseline, 39.8% of patients with IEI were men, 55.6% were aged over 65 years, and 68.2% were White. Among the 86% of patients treated as inpatients for IEI, 81.3% were admitted through the emergency department; 60.5% were discharged to home, 26.5% to a nursing facility, and 8.4% died. Over 14% (n=9415) of patients were identified in outpatient settings.

Common IEI diagnoses were urosepsis (66.0%), other bloodstream infections (22.1%), and wound infections (6.8%). IEI was determined to be hospital acquired among 8.7% and healthcare acquired among 24.9%.

IEI recurred among 30.2 events per 1000 patients. Prostate biopsy increased recurrence rates (136.4 events per 1000 patients).

Among patients with a recurrence (n=1764), average time to first recurrence was 117.2±96.1 days. Recurrence occurred sooner among patients who had a prostate biopsy, compared with other bloodstream infections, complicated pneumonia, or urosepsis.

Among the patients who were assessed for antibiotic susceptibility (n=41,696), 28.22% were fluroquinolone resistant, 9.18% extended-spectrum cephalosporin resistant, and 0.14% carbapenem resistant. Stratified by hospitalization date, resistance to extended-spectrum cephalosporin has been escalating from 5.46% in 2009 to 12.97% in 2016 (P <.05).

This study may have been biased by only considering recurrence among patients who were readmitted to the same hospital.

These findings indicated older inpatients were at elevated risk for IEI, most commonly caused by urosepsis or other bloodstream infections. Resistance to fluroquinolone antibiotics was relatively common (>25%) and extended-spectrum cephalosporin resistance has been increasing in recent decades. Additional studies are needed for prevention of IEI in the United States.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Begier E, Rosenthal N A, Gurtman A, et al. epidemiology of invasive escherichia coli infection and antibiotic resistance status among patients treated in U.S. hospitals: 2009–2016. Clin Infect Dis. 2021;ciab005. doi:10.1093/cid/ciab005.