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Impact of host-pathogen-treatment tripartite components on early mortality of patients with Escherichia coli bloodstream infection: Prospective observational study

 Eun-Jeong Yoon  ;  Min Hyuk Choi  ;  Yoon Soo Park  ;  Hye Sun Lee  ;  Dokyun Kim  ;  Hyukmin Lee  ;  Kyeong Seob Shin  ;  Jong Hee Shine  ;  Young Uh  ;  Young Ah Kim  ;  Jeong Hwan Shing  ;  SeokHoon Jeong 
 EBioMedicine, Vol.35 : 76-86, 2018 
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Bloodstream infection ; CTX-M ESBL ; Delayed definitive treatment ; Early mortality ; Escherichia coli ; ST131
BACKGROUND: Risk factors affecting early morality of patients with Escherichia coli bloodstream infection (BSI) were investigated including the host-pathogen-treatment tripartite components. METHODS: Six general hospitals in South Korea participated in this multicentre prospective observational study from May 2016 to April 2017 and a total of 1492 laboratory-confirmed E. coli BSI cases were studied. Cox regression was used to estimate risks of the primary endpoint, i.e., all-cause mortality within 30 days from the initial blood culture. Six multivariate analysis models were constructed in accordance to the clinical importance and intra- and inter-component multicollinearity. FINDINGS: Among the 1492 E. coli BSI cases, 9.5% (n = 141) patients expired within 30 days. Six models of multivariate analysis indicated risk factors of critical illness, primary infection of peritoneum, and chronic liver disease including cirrhosis for host variables; of phylogenetic group B2, ST131-sublineage H30Rx, multidrug resistance, group 1 CTX-M extended-spectrum beta-lactamase production, and having either of fyuA, afa, and sfa/foc virulence genes for causative E. coli pathogen variables; and of delayed definitive therapy for antimicrobial treatment variables. In addition, as a protective factor, primary urinary tract infection was identified. INTERPRETATION: Despite decades' effort searching for the risk factors for E. coli BSI, systemic understanding covering the entire tripartite component is still lacking. This study detailed the organic impact of host-pathogen-treatment tripartite components for early mortality in patients with E. coli BSI.
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1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
김도균(Kim, Dokyun) ORCID logo https://orcid.org/0000-0002-0348-5440
이혁민(Lee, Hyuk Min) ORCID logo https://orcid.org/0000-0002-8523-4126
정석훈(Jeong, Seok Hoon) ORCID logo https://orcid.org/0000-0001-9290-897X
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