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 | |
| Publication status | Published - 2018 Sep |
Fingerprint
All Science Journal Classification (ASJC) codes
- Biochemistry, Genetics and Molecular Biology(all)
Cite this
}
Impact of host-pathogen-treatment tripartite components on early mortality of patients with Escherichia coli bloodstream infection : Prospective observational study. / Yoon, Eun Jeong; Choi, Min Hyuk; Park, Yoon Soo; Lee, Hye Sun; Kim, Dokyun; Lee, Hyukmin; Shin, Kyeong Seob; Shin, Jong Hee; Uh, Young; Kim, Young Ah; Shin, Jeong Hwan; Jeong, Seok Hoon.
In: EBioMedicine, Vol. 35, 09.2018, p. 76-86.Research output: Contribution to journal › Article
TY - JOUR
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
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.
UR - http://www.scopus.com/inward/record.url?scp=85051715250&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85051715250&partnerID=8YFLogxK
U2 - 10.1016/j.ebiom.2018.08.029
DO - 10.1016/j.ebiom.2018.08.029
M3 - Article
C2 - 30139627
AN - SCOPUS:85051715250
VL - 35
SP - 76
EP - 86
JO - EBioMedicine
JF - EBioMedicine
SN - 2352-3964
ER -