Health inequalities in Escherichia coli bacteraemia and associated antibiotic resistance: a national surveillance study, England, 2018/19 to 2023/24

Abstract Background Health inequalities in Escherichia coli bacteraemia are increasingly recognised, with disadvantaged and minority groups disproportionately affected. Understanding intersecting inequality factors will clarify the poorly understood drivers of overall and resistant E. coli infections. Methods We retrospectively analysed English surveillance data (2018/19–2023/24) of E. coli bacteraemia and resistance. Multivariable logistic regression assessed healthcare- vs community-associated (HA vs CA) and resistant vs susceptible cases. Findings Between April 2018 and March 2024, 242,604 cases of E. coli bacteraemia were reported. Minority ethnic groups were disproportionately represented among patients aged <75 years, in both HA and CA categories. CA cases in females aged 30-44 were 2.7, 4.2, 4.4 and 4.0 times greater in Asian, Black, Mixed and Other ethnicities vs their White counterparts. Multivariable analysis showed odds of antibiotic resistant E. coli bacteraemia were more than twice that in the Asian (OR 2.45, p<0.0001), and 51.0% greater in the Black (p<0.0001) ethnicities, respectively, compared to their White counterparts. Odds of resistance amongst the Asian ethnic group was twice the national average for 2nd (37.2 vs 18.3%) and 3rd generation cephalosporins (35.2 vs 16.1%) and ciprofloxacin (37.1 vs 17.9%). Residing within a care home more than doubled the odds of resistant infection (OR 2.28, p<0.0001). Conclusions Younger individuals of ethnic minorities particularly females experienced a disproportionate burden of infection, with resistance to key antibiotics particularly elevated in the Asian population. Care home residents had significantly higher rates of CA and resistant E. coli bacteraemia. Greater understanding of the source of infection in these groups is essential to inform targeted interventions.