O-serotype distribution of Escherichia coli bloodstream infection isolates in critically ill patients in The Netherlands

Risk of Invasive Escherichia coli (E. coli) Disease After Elective Urologic Procedures Among Older Adults in the United States

INTRODUCTION

Little is known about the risk of invasive E. coli disease (IED) after elective urologic procedures. We estimated the risk of IED after selected urologic procedures in patients with or without antibiotic prophylaxis, and in controls with no urologic or other surgical procedures.

METHODS

The Komodo Research Database (01/01/2021-06/30/2023) was used to identify patients ≥ 60 years old with selected urological procedures (index: first urologic procedure date) and randomly selected controls without surgical procedures (index: random date). Patients with urologic procedures were classified into two cohorts based on whether or not they received antibiotic prophylaxis within 14 days prior to and on index date. Entropy balancing adjusted for differences between groups in selected patient characteristics over 6 months pre-index (baseline). IED rates within 30 days post-index were assessed based on recorded diagnosis of E. coli sepsis (ICD-10-CM: A41.51); odds ratios (OR) were estimated using weighted logistic regression. Sensitivity analyses within 90 days and using broader claims-based algorithm for IED were performed.

RESULTS

Overall, 141,418 patients had urologic procedures with antibiotic prophylaxis, 200,062 had them without antibiotic prophylaxis, and 424,254 had no procedures. Within 30 days post-index, IED rates were 0.48% and 0.72% among patients with or without antibiotic prophylaxis, respectively, vs. 0.02% among those without any procedures. Among patients with urologic procedures,  > 70% of IED events occurred within 30 days. Patients who had urologic procedures without prophylaxis had a higher risk of developing IED than those with prophylaxis (OR = 1.50, 95% confidence interval [CI: 1.37-1.65]), while patients without any procedures had a lower risk than those with urologic procedures and prophylaxis (OR = 0.04, 95% CI [0.03-0.05]). Similar results were obtained in sensitivity analyses.

CONCLUSIONS

Urologic procedures were associated with an increased IED risk even with antibiotic prophylaxis. Results suggest an unmet need for additional preventative measures to reduce the burden of IED after urologic procedures.

Development and performance characteristics of novel code-based algorithms to identify invasive Escherichia coli disease

PURPOSE

Evaluation of novel code-based algorithms to identify invasive Escherichia coli disease (IED) among patients in healthcare databases.

METHODS

Inpatient visits with microbiological evidence of invasive bacterial disease were extracted from the Optum^© electronic health record database between 01 January 2016 and 30 June 2020. Six algorithms, derived from diagnosis and drug exposure codes associated to infectious diseases and Escherichia coli, were developed to identify IED. The performance characteristics of algorithms were assessed using a reference standard derived from microbiology data.

RESULTS

Among 97,194 eligible records, 25,310 (26.0%) were classified as IED. Algorithm 1 (diagnosis code for infectious invasive disease due to E. coli) had the highest positive predictive value (PPV; 96.0%) and lowest sensitivity (60.4%). Algorithm 2, which additionally included patients with diagnosis codes for infectious invasive disease due to an unspecified organism, had the highest sensitivity (95.5%) and lowest PPV (27.8%). Algorithm 4, which required patients with a diagnosis code for infectious invasive disease due to unspecified organism to have no diagnosis code for non-E. coli infections, achieved the most balanced performance characteristics (PPV, 93.6%; sensitivity, 78.1%; F₁ score, 85.1%). Finally, adding exposure to antibiotics in the treatment of E. coli had limited impact on performance algorithms 5 and 6.

CONCLUSION

Algorithm 4, which achieved the most balanced performance characteristics, offers a useful tool to identify patients with IED and assess the burden of IED in healthcare databases. This article is protected by copyright. All rights reserved.

Global Distribution of O Serotypes and Antibiotic Resistance in Extraintestinal Pathogenic Escherichia coli Collected From the Blood of Patients With Bacteremia Across Multiple Surveillance Studies

BACKGROUND

Extraintestinal pathogenic Escherichia coli (ExPEC) is the leading cause of bacteremia worldwide, with older populations having increased risk of invasive bacterial disease. Increasing resistance to first-line antibiotics and emergence of multidrug-resistant (MDR) strains represent major treatment challenges. ExPEC O serotypes are key targets for potential multivalent conjugate vaccine development. Therefore, we evaluated the O serotype distribution and antibiotic resistance profiles of ExPEC strains causing bloodstream infections across 4 regions.

METHODS

Blood culture isolates from patients aged ≥60 years collected during 5 retrospective E. coli surveillance studies in Europe, North America, Asia-Pacific, and South America (2011-2017) were analyzed. Isolates were O serotyped by agglutination; O genotyping was performed for nontypeable isolates. Antimicrobial susceptibility testing was also conducted.

RESULTS

Among 3217 ExPEC blood culture isolates, the most ubiquitous O serotype was O25 (n = 737 [22.9%]), followed by O2, O6, O1, O75, O15, O8, O16, O4, O18, O77 group, O153, O9, O101/O162, O86, and O13 (prevalence of ≥1%). The prevalence of these O serotypes was generally consistent across regions, apart from South America; together, these 16 O serotypes represented 77.6% of all ExPEC bacteremia isolates analyzed. The overall MDR frequency was 10.7%, with limited variation between regions. Within the MDR subset (n = 345), O25 showed a dominant prevalence of 63.2% (n = 218).

CONCLUSIONS

Predominant O serotypes among ExPEC bacteremia isolates are widespread across different regions. O25 was the most prevalent O serotype overall and particularly dominant among MDR isolates. These findings may inform the design of multivalent conjugate vaccines that can target the predominant O serotypes associated with invasive ExPEC disease in older adults.

The role of vaccines in combating antimicrobial resistance (AMR) bacteria

Most pathogens have developed an intrinsic capacity to thrive by developing resistance to antimicrobial compounds utilized in treatment. Antimicrobial resistance arises when microbial agents such as bacteria, viruses, fungi, and parasites alter their behaviour to make current conventional medicines inefficient. Vaccination is one of the most effective strategies to fight antimicrobial resistance. Vaccines, unlike drugs, are less likely to produce resistance since they are precise to their target illnesses. Vaccines against infectious agents such as Streptococcus pneumoniae and Haemophilus influenzae have already been shown to reduce tolerance to antimicrobial medications; however, vaccines against some antimicrobial-resistant pathogens such as Vibrio cholerae, Salmonella typhi, Escherichia coli, nosocomial infections, and pulmonary and diarrheal disease viruses require more research and development. This paper describes vaccine roles in combatting antimicrobial resistance, quantifies the overall advantages of vaccination as an anti-antimicrobial resistance approach, analyzes existing antimicrobial vaccines and those currently under development, and emphasizes some of the obstacles and prospects of vaccine research and development.