Cargando…

1457. Escherichia coli Community Acquired Pneumonia

BACKGROUND: Escherichia coli has been thought to be an uncommon cause of community-acquired pneumonia (CAP). Large epidemiological data on E. coli CAP (E-CAP) and its comparison to pneumococcal CAP (P-CAP) are lacking. METHODS: A multi-center retrospective cohort study of adult patients (aged ≥ 18 y...

Descripción completa

Detalles Bibliográficos
Autores principales: John, Teny Mathew, Deshpande, Abhishek, Haessler, Sarah, Brizendine, Kyle, Yu, Pei-Chun, Imrey, Peter, Rothberg, Michael B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252561/
http://dx.doi.org/10.1093/ofid/ofy210.1287
_version_ 1783373291059150848
author John, Teny Mathew
Deshpande, Abhishek
Haessler, Sarah
Brizendine, Kyle
Yu, Pei-Chun
Imrey, Peter
Rothberg, Michael B
author_facet John, Teny Mathew
Deshpande, Abhishek
Haessler, Sarah
Brizendine, Kyle
Yu, Pei-Chun
Imrey, Peter
Rothberg, Michael B
author_sort John, Teny Mathew
collection PubMed
description BACKGROUND: Escherichia coli has been thought to be an uncommon cause of community-acquired pneumonia (CAP). Large epidemiological data on E. coli CAP (E-CAP) and its comparison to pneumococcal CAP (P-CAP) are lacking. METHODS: A multi-center retrospective cohort study of adult patients (aged ≥ 18 years) admitted to 140 US hospitals with pneumonia and/or sepsis from 2010–2015, included in the Premier Research database. Patients with community-onset infection, antibiotic treatment beginning within the first 2 hospital days, and continued for at least 3 consecutive days were included. Patients were excluded if they had been transferred from another acute care facility, had cystic fibrosis, had a hospital length of stay of 1 day or less, co-existent urinary tract infection, gastrointestinal/ intra-abdominal infection, or simultaneous presence of other CAP pathogens. Pneumonia and sepsis were identified by ICD-9 codes. RESULTS: A total of 13,165 patients met the inclusion criteria, of which 1,247 had E. coli CAP. Majority of patients with E-CAP were nonnursing home residents (90.2%, 1,125/1,247). 69.3% (864/1,247) patients with E-CAP presented with”sepsis syndrome’ compared with only 48.1% in other Gram-negative CAP and 62.5% in P-CAP. Aspiration pneumonia was diagnosed in 5.9% (73/1,247) with E-CAP. Blood cultures were positive in 59.9% (748/1,247) of patients with E-CAP with 84.8% positivity in patients with sepsis syndrome. Patients with E-CAP compared with P-CAP were more likely to require ICU-level care (42.6% vs. 38.2%), mechanical ventilation (19.3% vs. 15.7%), and require vasopressors (21% vs. 13.8%). In-hospital mortality was 14.8% in E-CAP compared with 7.4% in P-CAP. The median cost of hospitalization was great in E-CAP than P-CAP ($12,420.1 vs. $9,857.5) Re-admission within 30 days was greater among patients with E-CAP than P-CAP (5.4% vs. 4%). 36.8% of isolates were resistant to fluoroquinolones, 10.4% to ceftriaxone and 18.1% to aminoglycosides. Only 10/1,247(0.8%) were multi-drug-resistant. CONCLUSION: E. coli is an important cause of severe CAP, with higher mortality, greater need for ICU-level care, and higher re-admission rates than patients with pneumococcal pneumonia. The rate of fluoroquinolone resistance was high and empiric quinolones should be used with caution for patients who are critically ill due to E-CAP DISCLOSURES: A. Deshpande, 3M: Investigator, Research support; Clorox: Investigator and Speaker’s Bureau, Research grant and Speaker honorarium; Merck: Investigator and Speaker’s Bureau, Research support.
format Online
Article
Text
id pubmed-6252561
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-62525612018-11-28 1457. Escherichia coli Community Acquired Pneumonia John, Teny Mathew Deshpande, Abhishek Haessler, Sarah Brizendine, Kyle Yu, Pei-Chun Imrey, Peter Rothberg, Michael B Open Forum Infect Dis Abstracts BACKGROUND: Escherichia coli has been thought to be an uncommon cause of community-acquired pneumonia (CAP). Large epidemiological data on E. coli CAP (E-CAP) and its comparison to pneumococcal CAP (P-CAP) are lacking. METHODS: A multi-center retrospective cohort study of adult patients (aged ≥ 18 years) admitted to 140 US hospitals with pneumonia and/or sepsis from 2010–2015, included in the Premier Research database. Patients with community-onset infection, antibiotic treatment beginning within the first 2 hospital days, and continued for at least 3 consecutive days were included. Patients were excluded if they had been transferred from another acute care facility, had cystic fibrosis, had a hospital length of stay of 1 day or less, co-existent urinary tract infection, gastrointestinal/ intra-abdominal infection, or simultaneous presence of other CAP pathogens. Pneumonia and sepsis were identified by ICD-9 codes. RESULTS: A total of 13,165 patients met the inclusion criteria, of which 1,247 had E. coli CAP. Majority of patients with E-CAP were nonnursing home residents (90.2%, 1,125/1,247). 69.3% (864/1,247) patients with E-CAP presented with”sepsis syndrome’ compared with only 48.1% in other Gram-negative CAP and 62.5% in P-CAP. Aspiration pneumonia was diagnosed in 5.9% (73/1,247) with E-CAP. Blood cultures were positive in 59.9% (748/1,247) of patients with E-CAP with 84.8% positivity in patients with sepsis syndrome. Patients with E-CAP compared with P-CAP were more likely to require ICU-level care (42.6% vs. 38.2%), mechanical ventilation (19.3% vs. 15.7%), and require vasopressors (21% vs. 13.8%). In-hospital mortality was 14.8% in E-CAP compared with 7.4% in P-CAP. The median cost of hospitalization was great in E-CAP than P-CAP ($12,420.1 vs. $9,857.5) Re-admission within 30 days was greater among patients with E-CAP than P-CAP (5.4% vs. 4%). 36.8% of isolates were resistant to fluoroquinolones, 10.4% to ceftriaxone and 18.1% to aminoglycosides. Only 10/1,247(0.8%) were multi-drug-resistant. CONCLUSION: E. coli is an important cause of severe CAP, with higher mortality, greater need for ICU-level care, and higher re-admission rates than patients with pneumococcal pneumonia. The rate of fluoroquinolone resistance was high and empiric quinolones should be used with caution for patients who are critically ill due to E-CAP DISCLOSURES: A. Deshpande, 3M: Investigator, Research support; Clorox: Investigator and Speaker’s Bureau, Research grant and Speaker honorarium; Merck: Investigator and Speaker’s Bureau, Research support. Oxford University Press 2018-11-26 /pmc/articles/PMC6252561/ http://dx.doi.org/10.1093/ofid/ofy210.1287 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
John, Teny Mathew
Deshpande, Abhishek
Haessler, Sarah
Brizendine, Kyle
Yu, Pei-Chun
Imrey, Peter
Rothberg, Michael B
1457. Escherichia coli Community Acquired Pneumonia
title 1457. Escherichia coli Community Acquired Pneumonia
title_full 1457. Escherichia coli Community Acquired Pneumonia
title_fullStr 1457. Escherichia coli Community Acquired Pneumonia
title_full_unstemmed 1457. Escherichia coli Community Acquired Pneumonia
title_short 1457. Escherichia coli Community Acquired Pneumonia
title_sort 1457. escherichia coli community acquired pneumonia
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252561/
http://dx.doi.org/10.1093/ofid/ofy210.1287
work_keys_str_mv AT johntenymathew 1457escherichiacolicommunityacquiredpneumonia
AT deshpandeabhishek 1457escherichiacolicommunityacquiredpneumonia
AT haesslersarah 1457escherichiacolicommunityacquiredpneumonia
AT brizendinekyle 1457escherichiacolicommunityacquiredpneumonia
AT yupeichun 1457escherichiacolicommunityacquiredpneumonia
AT imreypeter 1457escherichiacolicommunityacquiredpneumonia
AT rothbergmichaelb 1457escherichiacolicommunityacquiredpneumonia