Impact of host-pathogen-treatment tripartite components on early mortality of patients with Escherichia coli bloodstream infection: Prospective observational study

Eun Jeong Yoon; Min Hyuk Choi; Yoon Soo Park; Hye Sun Lee; Dokyun Kim; Hyukmin Lee; Kyeong Seob Shin; Jong Hee Shin; Young Uh; Young Ah Kim; Jeong Hwan Shin; Seok Hoon Jeong

doi:10.1016/j.ebiom.2018.08.029

Impact of host-pathogen-treatment tripartite components on early mortality of patients with Escherichia coli bloodstream infection: Prospective observational study

Eun Jeong Yoon, Min Hyuk Choi, Yoon Soo Park, Hye Sun Lee, Dokyun Kim, Hyukmin Lee, Kyeong Seob Shin, Jong Hee Shin, Young Uh, Young Ah Kim, Jeong Hwan Shin, Seok Hoon Jeong

Department of Laboratory Medicine

Research output: Contribution to journal › Article › peer-review

19 Citations (Scopus)

Abstract

Background: Risk factors affecting early morality of patients with Escherichia coli bloodstream infection (BSI) were investigated including the host-pathogen-treatment tripartite components. Methods: Six general hospitals in South Korea participated in this multicentre prospective observational study from May 2016 to April 2017 and a total of 1492 laboratory-confirmed E. coli BSI cases were studied. Cox regression was used to estimate risks of the primary endpoint, i.e., all-cause mortality within 30 days from the initial blood culture. Six multivariate analysis models were constructed in accordance to the clinical importance and intra- and inter-component multicollinearity. Findings: Among the 1492 E. coli BSI cases, 9.5% (n = 141) patients expired within 30 days. Six models of multivariate analysis indicated risk factors of critical illness, primary infection of peritoneum, and chronic liver disease including cirrhosis for host variables; of phylogenetic group B2, ST131-sublineage H30Rx, multidrug resistance, group 1 CTX-M extended-spectrum beta-lactamase production, and having either of fyuA, afa, and sfa/foc virulence genes for causative E. coli pathogen variables; and of delayed definitive therapy for antimicrobial treatment variables. In addition, as a protective factor, primary urinary tract infection was identified. Interpretation: Despite decades’ effort searching for the risk factors for E. coli BSI, systemic understanding covering the entire tripartite component is still lacking. This study detailed the organic impact of host-pathogen-treatment tripartite components for early mortality in patients with E. coli BSI.

Original language	English
Pages (from-to)	76-86
Number of pages	11
Journal	EBioMedicine
Volume	35
DOIs	https://doi.org/10.1016/j.ebiom.2018.08.029
Publication status	Published - 2018 Sep

Bibliographical note

Funding Information:
This work was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention ( 2017E4400100# ). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Publisher Copyright:
© 2018 The Authors

All Science Journal Classification (ASJC) codes

Biochemistry, Genetics and Molecular Biology(all)

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10.1016/j.ebiom.2018.08.029

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Yoon, E. J., Choi, M. H., Park, Y. S., Lee, H. S., Kim, D., Lee, H., Shin, K. S., Shin, J. H., Uh, Y., Kim, Y. A., Shin, J. H., & Jeong, S. H. (2018). Impact of host-pathogen-treatment tripartite components on early mortality of patients with Escherichia coli bloodstream infection: Prospective observational study. EBioMedicine, 35, 76-86. https://doi.org/10.1016/j.ebiom.2018.08.029

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title = "Impact of host-pathogen-treatment tripartite components on early mortality of patients with Escherichia coli bloodstream infection: Prospective observational study",

abstract = "Background: Risk factors affecting early morality of patients with Escherichia coli bloodstream infection (BSI) were investigated including the host-pathogen-treatment tripartite components. Methods: Six general hospitals in South Korea participated in this multicentre prospective observational study from May 2016 to April 2017 and a total of 1492 laboratory-confirmed E. coli BSI cases were studied. Cox regression was used to estimate risks of the primary endpoint, i.e., all-cause mortality within 30 days from the initial blood culture. Six multivariate analysis models were constructed in accordance to the clinical importance and intra- and inter-component multicollinearity. Findings: Among the 1492 E. coli BSI cases, 9.5% (n = 141) patients expired within 30 days. Six models of multivariate analysis indicated risk factors of critical illness, primary infection of peritoneum, and chronic liver disease including cirrhosis for host variables; of phylogenetic group B2, ST131-sublineage H30Rx, multidrug resistance, group 1 CTX-M extended-spectrum beta-lactamase production, and having either of fyuA, afa, and sfa/foc virulence genes for causative E. coli pathogen variables; and of delayed definitive therapy for antimicrobial treatment variables. In addition, as a protective factor, primary urinary tract infection was identified. Interpretation: Despite decades{\textquoteright} effort searching for the risk factors for E. coli BSI, systemic understanding covering the entire tripartite component is still lacking. This study detailed the organic impact of host-pathogen-treatment tripartite components for early mortality in patients with E. coli BSI.",

author = "Yoon, {Eun Jeong} and Choi, {Min Hyuk} and Park, {Yoon Soo} and Lee, {Hye Sun} and Dokyun Kim and Hyukmin Lee and Shin, {Kyeong Seob} and Shin, {Jong Hee} and Young Uh and Kim, {Young Ah} and Shin, {Jeong Hwan} and Jeong, {Seok Hoon}",

note = "Funding Information: This work was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention ( 2017E4400100# ). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Publisher Copyright: {\textcopyright} 2018 The Authors",

year = "2018",

month = sep,

doi = "10.1016/j.ebiom.2018.08.029",

language = "English",

volume = "35",

pages = "76--86",

journal = "EBioMedicine",

issn = "2352-3964",

publisher = "Elsevier BV",

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T1 - Impact of host-pathogen-treatment tripartite components on early mortality of patients with Escherichia coli bloodstream infection

T2 - Prospective observational study

AU - Yoon, Eun Jeong

AU - Choi, Min Hyuk

AU - Park, Yoon Soo

AU - Lee, Hye Sun

AU - Kim, Dokyun

AU - Lee, Hyukmin

AU - Shin, Kyeong Seob

AU - Shin, Jong Hee

AU - Uh, Young

AU - Kim, Young Ah

AU - Shin, Jeong Hwan

AU - Jeong, Seok Hoon

N1 - Funding Information: This work was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention ( 2017E4400100# ). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Publisher Copyright: © 2018 The Authors

PY - 2018/9

Y1 - 2018/9

N2 - Background: Risk factors affecting early morality of patients with Escherichia coli bloodstream infection (BSI) were investigated including the host-pathogen-treatment tripartite components. Methods: Six general hospitals in South Korea participated in this multicentre prospective observational study from May 2016 to April 2017 and a total of 1492 laboratory-confirmed E. coli BSI cases were studied. Cox regression was used to estimate risks of the primary endpoint, i.e., all-cause mortality within 30 days from the initial blood culture. Six multivariate analysis models were constructed in accordance to the clinical importance and intra- and inter-component multicollinearity. Findings: Among the 1492 E. coli BSI cases, 9.5% (n = 141) patients expired within 30 days. Six models of multivariate analysis indicated risk factors of critical illness, primary infection of peritoneum, and chronic liver disease including cirrhosis for host variables; of phylogenetic group B2, ST131-sublineage H30Rx, multidrug resistance, group 1 CTX-M extended-spectrum beta-lactamase production, and having either of fyuA, afa, and sfa/foc virulence genes for causative E. coli pathogen variables; and of delayed definitive therapy for antimicrobial treatment variables. In addition, as a protective factor, primary urinary tract infection was identified. Interpretation: Despite decades’ effort searching for the risk factors for E. coli BSI, systemic understanding covering the entire tripartite component is still lacking. This study detailed the organic impact of host-pathogen-treatment tripartite components for early mortality in patients with E. coli BSI.

AB - Background: Risk factors affecting early morality of patients with Escherichia coli bloodstream infection (BSI) were investigated including the host-pathogen-treatment tripartite components. Methods: Six general hospitals in South Korea participated in this multicentre prospective observational study from May 2016 to April 2017 and a total of 1492 laboratory-confirmed E. coli BSI cases were studied. Cox regression was used to estimate risks of the primary endpoint, i.e., all-cause mortality within 30 days from the initial blood culture. Six multivariate analysis models were constructed in accordance to the clinical importance and intra- and inter-component multicollinearity. Findings: Among the 1492 E. coli BSI cases, 9.5% (n = 141) patients expired within 30 days. Six models of multivariate analysis indicated risk factors of critical illness, primary infection of peritoneum, and chronic liver disease including cirrhosis for host variables; of phylogenetic group B2, ST131-sublineage H30Rx, multidrug resistance, group 1 CTX-M extended-spectrum beta-lactamase production, and having either of fyuA, afa, and sfa/foc virulence genes for causative E. coli pathogen variables; and of delayed definitive therapy for antimicrobial treatment variables. In addition, as a protective factor, primary urinary tract infection was identified. Interpretation: Despite decades’ effort searching for the risk factors for E. coli BSI, systemic understanding covering the entire tripartite component is still lacking. This study detailed the organic impact of host-pathogen-treatment tripartite components for early mortality in patients with E. coli BSI.

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Impact of host-pathogen-treatment tripartite components on early mortality of patients with Escherichia coli bloodstream infection: Prospective observational study

Abstract

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