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Escherichia coli ranks among the organisms most frequently isolated from cases of bacteremia. The relative contribution of the host and bacteria to E. coli bacteremia severity remains unknown. We conducted a prospective multicenter cohort study to identify host and bacterial factors associated with E. coli bacteremia severity. The primary endpoint was in-hospital death, up to 28 days after the first positive blood culture. Among 1, 051 patients included, 136 (12. 9%) died. Overall, 604 (57. 5%) patients were female. The median age was 70 years, and 202 (19. 2%) episodes were nosocomial. The most frequent comorbidities were immunocompromised status (37. 9%), tobacco addiction (21. 5%), and diabetes mellitus (20. 1%). The most common portal of entry was the urinary tract (56. 9%). Most E. coli isolates belonged to phylogenetic group B2 (52. 0%). The multivariate analysis retained the following factors as predictive of death: older age (odds ratio OR = 1. 25 95% confidence interval CI, 1. 09 to 1. 43 for each 10-year increment), cirrhosis (OR = 4. 85 95% CI, 2. 49 to 9. 45), hospitalization before bacteremia (OR = 4. 13 95% CI, 2. 49 to 6. 82), being an immunocompromised patient not hospitalized before bacteremia (OR = 3. 73 95% CI, 2. 25 to 6. 18), and a cutaneous portal of entry (OR = 6. 45 95% CI, 1. 68 to 24. 79) ; a urinary tract portal of entry and the presence of the ireA virulence gene were negatively correlated with death (OR = 0. 46 95% CI, 0. 30 to 0. 70 and OR = 0. 53 95% CI, 0. 30 to 0. 91, respectively). In summary, host factors and the portal of entry outweigh bacterial determinants for predicting E. coli bacteremia severity.
Lefort et al. (Thu,) studied this question.