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

Research output: Contribution to journalArticle

2 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 languageEnglish
Pages (from-to)76-86
Number of pages11
JournalEBioMedicine
Volume35
DOIs
Publication statusPublished - 2018 Sep

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Escherichia coli Infections
Pathogens
Escherichia coli
Observational Studies
Prospective Studies
Mortality
Multivariate Analysis
Therapeutics
Republic of Korea
Peritoneum
Multiple Drug Resistance
beta-Lactamases
Critical Illness
Urinary Tract Infections
General Hospitals
Virulence
Liver Diseases
Fibrosis
Chronic Disease
Liver

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

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. / Impact of host-pathogen-treatment tripartite components on early mortality of patients with Escherichia coli bloodstream infection : Prospective observational study. In: EBioMedicine. 2018 ; Vol. 35. pp. 76-86.
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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.",
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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 journalArticle

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

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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

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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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