Healthcare Associated Infection and Antimicrobial Resistance Department, Public Health England, Colindale, London, UK.
Healthcare Associated Infection and Antimicrobial Resistance Department, Public Health England, Colindale, London, UK.
Clin Microbiol Infect. 2015 Mar;21(3):251.e1-8. doi: 10.1016/j.cmi.2015.01.001. Epub 2015 Jan 14.
Escherichia coli is the commonest cause of bacteraemia in England, with an incidence of 50.7 cases per 100 000 population in 2011. We undertook a large national study to estimate and identify risk factors for 30-day all-cause mortality in E. coli bacteraemia patients. Records for patients with E. coli bacteraemia reported to the English national mandatory surveillance system between 1 July 2011 and 30 June 2012 were linked to death registrations to determine 30-day all-cause mortality. A multivariable regression model was used to identify factors associated with 30-day all-cause mortality. There were 5220 deaths in 28 616 E. coli bacteraemia patients, a mortality rate of 18.2% (95% CI 17.8-18.7%). Three-quarters of deaths occurred within 14 days of specimen collection. Factors independently associated with increased mortality were: age < 1 year or > 44 years; an underlying respiratory or unknown infection focus; ciprofloxacin non-susceptibility; hospital-onset infection or not being admitted; and bacteraemia occurring in the winter. Female gender and a urogenital focus were associated with a reduction in mortality. This is the first national study of mortality among E. coli bacteraemia patients in England. Interventions to reduce mortality need to be multifaceted and include both primary and secondary healthcare providers. Greater awareness of the risk factors for and symptoms of E. coli bacteraemia may prompt earlier diagnosis and treatment. Changes in antimicrobial resistance patterns need to be monitored for their potential impact on infection and mortality.
大肠埃希菌是英格兰血源性感染最常见的病原体，2011 年发病率为每 10 万人中有 50.7 例。我们进行了一项大型全国性研究，旨在评估和确定大肠埃希菌血源性感染患者 30 天全因死亡率的危险因素。将 2011 年 7 月 1 日至 2012 年 6 月 30 日期间向英国国家强制性监测系统报告的大肠埃希菌血源性感染患者的记录与死亡登记数据相链接，以确定 30 天全因死亡率。采用多变量回归模型确定与 30 天全因死亡率相关的因素。在 28616 例大肠埃希菌血源性感染患者中，有 5220 例死亡，死亡率为 18.2%（95%CI 17.8-18.7%）。四分之三的死亡发生在采集标本后 14 天内。与死亡率增加独立相关的因素包括：年龄<1 岁或>44 岁；存在基础呼吸道或未知感染病灶；对环丙沙星耐药；医院获得性感染或未入院；以及冬季发生血源性感染。女性和泌尿生殖道感染病灶与死亡率降低相关。这是英国首次对大肠埃希菌血源性感染患者死亡率进行的全国性研究。需要采取多方面措施来降低死亡率，包括初级和二级医疗保健提供者。提高对大肠埃希菌血源性感染的风险因素和症状的认识，可能会促使更早地进行诊断和治疗。需要监测抗菌药物耐药性模式的变化，以了解其对感染和死亡率的潜在影响。
