National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel.
National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel.
Clin Microbiol Infect. 2022 Jun;28(6):879.e1-879.e7. doi: 10.1016/j.cmi.2021.12.009. Epub 2021 Dec 15.
Escherichia coli is the leading cause of bloodstream infection (BSI). The incidence of E. coli BSI caused by antibiotic-resistant strains is increasing. We aimed to describe the nationwide incidence and resistance profile of E. coli BSI in Israel and its impact on mortality, to compare E. coli BSI mortality with all-cause mortality, and community-onset with hospital-onset E. coli BSIs.
We used mandatory BSI surveillance reports submitted by all Israeli hospitals to the Ministry of Health and the national death registry. All E. coli BSIs from 1 January 2018 to 31 December 31 2019 in patients aged 18 and over were included.
A total of 11 113 E. coli BSIs occurred in 10 218 patients; 85% (9012/10 583) were community onset. Median age was 76 (IQR 65-85), and 57% (6304/11 113) of cases occurred in women. The annual incidence was 92.5 per 100 000 population. Antibiotic resistance was frequent and significantly more common in hospital-onset than in community-onset BSI; 65% (1021/1571) vs. 45% (4049/9012) were multidrug-resistant (MDR) (p < 0.001). The case fatality rate (CFR) was higher following hospital-onset BSI than community-onset: 23% (276/1214) vs. 12% (926/7620) at 14 days, 31% (378/1214) vs. 16% (1244/7620) at 30 days, and 55% (418/766) vs. 34% (1645/4903) at 1 year (p < 0.001 for all comparisons). The 1-year CFR was 47% (1258/2707) for MDR vs. 28% (928/3281) for non-MDR (p < 0.001). The annual mortality rate was 31.0 per 100 000 population, comprising 4.2% (31.0/734.8) of all causes of deaths.
E. coli BSI carries a high burden, with a large proportion of MDR isolates, which are associated with increased incidence and CFR.
大肠杆菌是血流感染（BSI）的主要原因。由耐药菌株引起的大肠杆菌 BSI 的发病率正在上升。我们旨在描述以色列全国范围内大肠杆菌 BSI 的发病率和耐药谱及其对死亡率的影响，比较大肠杆菌 BSI 死亡率与全因死亡率，以及社区发病与医院发病的大肠杆菌 BSI。
我们使用了所有以色列医院向卫生部和国家死亡登记处提交的强制性 BSI 监测报告。纳入了 2018 年 1 月 1 日至 2019 年 12 月 31 日期间年龄在 18 岁及以上的所有大肠杆菌 BSI 患者。
共发生了 11113 例大肠杆菌 BSI，涉及 10583 例患者；85%（9012/10583）为社区发病。中位年龄为 76（65-85）岁，57%（6304/11113）的病例发生在女性。年发病率为每 100000 人 92.5 例。耐药性很常见，且医院发病的大肠杆菌 BSI 比社区发病的大肠杆菌 BSI 更为常见；65%（1021/1571）比 45%（4049/9012）为多重耐药（MDR）（p<0.001）。与社区发病相比，医院发病的大肠杆菌 BSI 的病死率更高：14 天时分别为 23%（276/1214）和 12%（926/7620），30 天时分别为 31%（378/1214）和 16%（1244/7620），1 年时分别为 55%（418/766）和 34%（1645/4903）（所有比较均为 p<0.001）。MDR 大肠杆菌 BSI 的 1 年病死率为 47%（1258/2707），而非 MDR 大肠杆菌 BSI 的病死率为 28%（928/3281）（p<0.001）。每年的死亡率为每 100000 人 31.0 例，占所有死亡原因的 4.2%（31.0/734.8）。
大肠杆菌 BSI 负担沉重，其耐药分离株比例较大，与发病率和病死率增加有关。
