1823. Clinical Profile and Antimicrobial Susceptibility of Invasive Extraintestinal Pathogenic Escherichia coli Disease in Hospitalized Adults Aged ≥60 Years
Authors: Doua Joachim , Baño Jesús Rodriguez , Geurtsen Jeroen , Go Oscar , Sarnecki Michal , Vilken Tuba , Spiessens Bart , Vallejo Christine , Goossens Herman , Bonten Marc , Poolman Jan , Ekkelenkamp Miquel 
Published: December 2022

Abstract

Background
Invasive extraintestinal pathogenic Escherichia coli disease (IED) occurs more frequently with increasing age, and antimicrobial resistance (AMR) can complicate treatment. Yet IED is under-monitored by major disease surveillance systems. In addition, the diagnosis of IED can be challenging due to the diversity of clinical presentations. More research is warranted to better characterize IED. Here we report EXPECT-2 (NCT04117113) results describing the clinical profile of IED and AMR patterns of causative E. coli isolates.

Methods
EXPECT-2 was a prospective observational study conducted in patients aged ≥60 years with an IED and hospitalized at 8 sites in Europe, North America, and Asia. Data were collected from October 24, 2019 to January 28, 2021. IED was determined by clinical criteria of either systemic inflammatory response syndrome (SIRS) or Sequential Organ Failure Assessment (SOFA), and a positive E. coli culture either from blood (bacteremic IED), or other normally sterile body site samples and/or urine (non-bacteremic IED).

Results
Overall, 240 IED patients were enrolled (median age, 75 years; females: 51%); 80.4% of IED cases were bacteremic and 19.6% were non-bacteremic. IED was community-acquired in 50.4%, hospital-acquired in 20.0%, and health care–associated in 29.6% of patients. The most common source of IED was urinary tract (62.9%). Fever occurred in 51.5%, tachycardia in 58.6%, tachypnea in 24.3%, and altered mentation in 15.7% of patients. Laboratory markers of a systemic infection were observed in 86.3% of patients, including leukocytosis in 42.7% and leukopenia in 10.9% of patients. SIRS criteria (≥ 2) were met in 65.8% and SOFA criteria (≥ 2) in 60.4% of patients. According to the investigator, 76.5% of patients met criteria for sepsis and 10.6% for septic shock. At 28 days post diagnosis, 14.6% of patients were unrecovered; 12.9% had a complication of kidney dysfunction, and 4.6% had died. Of 238 patients whose E. coli isolates were tested, the AMR rates for ≥ 1 antibiotic were 62.6% in ≥ 1 drug class, 45.9% in ≥ 2 drug classes, and 35.0% in ≥ 3 drug classes.

Conclusion
In patients aged ≥ 60 years, IED manifested as a severe infection. AMR was frequently observed. The data suggest a need of preventive interventions for IED.

Disclosures
Joachim Doua, MD, MPH, Janssen: Employee|Janssen: Stocks/Bonds Jeroen Geurtsen, PhD, Janssen: Employee of Janssen Vaccines & Prevention BV Oscar Go, PhD, Janssen: Employee of Janssen Research & Development LLC. Michal Sarnecki, MD, Janssen: Employee|Janssen: Stocks/Bonds Bart Spiessens, PhD, Janssen: Employee Marc Bonten, MD, PhD, Astra-Zeneca: Advisor/Consultant|Janssen: Advisor/Consultant|Merck: Advisor/Consultant|Novartis: Advisor/Consultant Jan Poolman, PhD, Janssen: Janssen Vaccines & Prevention B.V.|Janssen: Stocks/Bonds.