Impact of community-acquired invasive Escherichia coli disease on mortality and readmissions in elderly patients : a multi-center study in Germany

Abstract

Background

Extraintestinal pathogenic Escherichia coli (ExPEC) causes invasive E. coli disease (IED), resulting in significant morbidity and mortality, particularly among the elderly. IED can present as bacteremia or sepsis and poses serious health risks for adults aged ≥ 60 years, compounded by increasing antimicrobial resistance. However, real-world data on IED’s clinical burden and risk factors in Europe are sparse. This study systematically reviews medical charts across 11 hospitals in Germany to address this gap by evaluating the impact of IED on patient outcomes, mortality rates, and hospital readmission within the elderly cohort.

Through rigorous clinician review of all related medical records, we ensured accurate identification of patients with community-acquired, microbiologically confirmed, mono-infections due to E. coli. The results of this investigation not only confirm previous reports of elevated mortality rates associated with IED but also contribute essential epidemiological insights into the management of these serious infections among older adults. Methods

A retrospective medical chart review was conducted using data from 11 hospitals across Germany (January 2016–February 2020). Eligible IED cases were identified using separate criteria: patients with microbiologically confirmed E. coli in the blood or another sterile body site, and patients with E. coli identified in the urine that suffered from sepsis. Results were stratified by the absence or presence of antimicrobial resistance. Regression models were used to assess case fatality and readmission rates. Results

Among 134 IED cases, 107 (79.9%) were culture-confirmed bacteremic IED and 67 (50.0%) were antimicrobial resistant. Median age was 79 years. Fourteen (10.4%) patients died during index hospitalization and 41 (35.7%) were readmitted within 12 months. Almost 80% of patients showed a SOFA score increase of ≥2 points, and 9.0% suffered from septic shock. Bacteremic patients had higher readmission rates (35.8% versus 28.0%), and longer hospital stays (mean 13.1 days). Patients with AMR infections were admitted with significantly worse SOFA scores (3.5 versus 2.9; p=.048). Conclusions

These findings confirm IED poses a substantial burden among older patients in Germany, which is consistent with other published studies. The high fatality and readmission rates highlight the need for novel and effective IED intervention strategies.