Pathogenic Characteristics And Prognosis Of Community-acquired Bloodstream Infections Caused By Escherichia Coli

Objective: Bloodstream infection is a critical disease with a high mortality rate and Escherichia Coli(E.Coli)is a common pathogen of bloodstream infection.The purpose of this paper is to analyze the pathogenic bacteria distribution characteristics,drug sensitivity and resistance of patients with community-acquired bloodstream infections caused by E.Coli,to provide reference for the clinical rational selection of antibiotics,meanwhile,by analyzing the clinical data of the patients and exploring the risk factors relate to the prognosis,to provide a basis for the prognosis assessment.Methods:Retrospective analysis the drug sensitivity test results and clinical data of 100 patients with community-acquired bloodstream infections caused by E.Coli in the Affiliated Hospital of Southwest Medical University from January 2014 to December 2018.The statistical methods of univariate analysis are the Independent-Sample T test,the Chi-square test or Fisher's exact test and the Mann-Whitney U test.Multivariate binary classification Logistic regression method is used to analyze the risk factors affecting prognosis.Results:100 patients with community-acquired bloodstream infections caused by E.Coli aged 18 to 91,the median age is 64,and 64.0% of patients are over60 years old.There are 31(31.0%)males and 69(69.0%)females.86 patients combined with one or more underlying diseases.Compared with other underlying diseases,type 2 diabetes mellitus,hypertension,and urinary stoneare more common,while 14 patients have no underlying diseases.The urinary tract is the most common area of infection.The top three departments for detection of E.Coli are Urology(22.0%,22/100),Department of Respiratory and Critical Care Medicine(22.0%,22/100),and Endocrinology(14.0%,14/100).The top three departments for detection of ESBLs-producing E.Coli are the Department of Respiratory and Critical Care Medicine(15 strains),Urology(13 strains),Critical Care Medicine(6 strains).From 2014 to 2018,the detection number of E.Coli has no obvious upward trend.however,the detection number is higher from 2016 to 2018.The overall detection rate of ESBLs-producing E.Coli is 55.0%(55/100)from 2014 to 2018,during this period the individual detection rates of ESBLs-producing are 69.2%(9/13),63.6%(7/11),44.0%(11/25),50.0%(13/26),and 60.0%(15/25),The ESBLs-producing detection rate shows no significant change during the 5 years(?2=0.274,P=0.601).Drug susceptibility tests show that E.Coli has high resistance rate to ampicillin,aztreonam,ceftriaxone,ceftazidime,cefotaxime,cefazolin,cefepime,cefuroxime,piperacillin,trimethoprim-sulfamethoxazole and gentamicin.And E.Coli is highly sensitive to imipenem,meropenem,ertapenem.The resistance rate of ESBLs-positive group to antibacterials in our hospital[ampicillin(100.0% VS 68.9%),aztreonam(98.2% VS 0.0%),ceftriaxone(98.2% VS 0.0%),ceftazidime(98.2% VS 0.0%),cefotaxime(98.2% VS 0.0%),cefazolin(96.4% VS 20.0%),cefepime(100.0% VS 0.0%),cefuroxime(100.0% VS 4.4%),gentamicin(61.8% VS 31.1%),levofloxacin(63.6% VS20.0%),piperacillin(80.0% VS 53.3%),tobramycin(45.5% VS 13.3%)] ishigher than the ESBLs-negative group,P<0.05.Compared with good prognosis group,the drug resistance rate in the poor prognosis group is much higher[ampicillin(100.0% VS 80.0%),aztreonam(76.7% VS 44.3%),ceftriaxone(76.7% VS 44.3%),ceftazidime(76.7% VS 44.3%),and cefotaxime(76.7% VS44.3%),cefazolin(86.7% VS 51.4%),cefepime(76.7% VS 45.7%),and cefuroxime(83.3% VS 45.7%)],P<0.05.The univariate analysis results show that the poor prognosis group has more elderly people(Z=2.130,P=0.033),higher detection rate of ESBLs(?2=8.129,P=0.004),higher prevalence of type2 diabetes mellitus(?2=7.229,P=0.007),shorter hospital stays(Z=2.336,P=0.020),higher random blood glucose(Z=2.193,P=0.028),and lower albumin(t=2.565,P=0.012).Multivariate logistic regression analysis reveals that type 2 diabetes mellitus(OR=4.391,95%CI:1.228~15.694,P=0.023),positive ESBLs(OR=6.662,95%CI:2.076~21.377,P=0.001)and decreased albumin(OR=0.899,95%CI: 0.822~0.983,P=0.020)are the risk factors affecting the prognosis.Conclusions: 1.Type 2 diabetes mellitus,hypertension,and urinary stones are the common underlying diseases.Urinary tract is the most common area of infection.2.From 2014 to 2018,among 100 patients with community-acquired bloodstream infections caused by E.Coli,the overall detection rate of ESBLs-producing is 55.0%,and there is no significant change in the detection rate of ESBLs-producing during this period.3.Drug susceptibility tests of patients with community-acquired bloodstreaminfections caused by E.Coli show that there is a certain degree of resistance to antibacterial drugs except imipenem,meropenem,and ertapenem.ESBLs-positive strains have the higher resistance rate of antibacterials than ESBLs-negative strains.Compared with good prognosis group,the resistance rate of antimicrobials is much higher in poor prognosis group.4.Patients with type 2 diabetes mellitus,positive ESBLs,and decreased albumin may have a poor prognosis.