Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study
| dc.contributor.author | MacKinnon, Melissa C. | |
| dc.contributor.author | McEwen, Scott A. | |
| dc.contributor.author | Pearl, David L. | |
| dc.contributor.author | Lyytikäinen, Outi | |
| dc.contributor.author | Jacobsson, Gunnar | |
| dc.contributor.author | Collignon, Peter | |
| dc.contributor.author | Gregson, Daniel B. | |
| dc.contributor.author | Valiquette, Louis | |
| dc.contributor.author | Laupland, Kevin B. | |
| dc.date.accessioned | 2021-06-27T00:02:18Z | |
| dc.date.available | 2021-06-27T00:02:18Z | |
| dc.date.issued | 2021-06-25 | |
| dc.date.updated | 2021-06-27T00:02:18Z | |
| dc.description.abstract | Abstract Background Escherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each. Methods During 2014–2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014–2018), region (five areas), age (< 70-years-old, ≥70-years-old), sex (female, male), third-generation cephalosporin (3GC) resistance (susceptible, resistant), and location of onset (community-onset, hospital-onset). The European Union 28-country 2018 population was used to directly age and sex standardize mortality rates. We used a multivariable Poisson model to estimate factors associated with mortality rate, and year, region, age and sex were considered for inclusion. Results From 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those < 70-years-old or female. Conclusions In our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk. | |
| dc.identifier.citation | BMC Infectious Diseases. 2021 Jun 25;21(1):606 | |
| dc.identifier.doi | https://doi.org/10.1186/s12879-021-06326-x | |
| dc.identifier.uri | http://hdl.handle.net/1880/113540 | |
| dc.identifier.uri | https://doi.org/10.11575/PRISM/44282 | |
| dc.language.rfc3066 | en | |
| dc.rights.holder | The Author(s) | |
| dc.title | Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study | |
| dc.type | Journal Article |