Risk factors and mortality outcomes of extended-spectrum beta-lactamase producing  Escherichia coli bacteremia: A retrospective cohort study from two Indonesian referral hospitals

Background: Bacteremia caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) can lead to bloodstream infection and subsequent sepsis which increases morbidity and mortality. Evaluation of risk factors of infection by ESBL-producing E. coli is important as it can decrease inappropriate antibiotic use and mortality rates. This study aimed to identify the risk factors and mortality of bacteremia caused by ESBL-producing E. coli. Methods: This retrospective cohort study included inpatients with confirmed E. coli blood culture examinations from two referral hospitals in Jakarta, Indonesia. Data suspected as risk factors for ESBL-producing E. coli bacteremia (utilization of medical devices, age, Charlson Comorbidity Index, history of hospitalization, and history of antibiotic therapy) were collected for analysis. Clinical profiles and independent risk factors of ESBL-producing E. coli bacteremia associated mortality were also evaluated. Results: A total of 116 subjects were analyzed with 81% aged ≥18 years old. The most common source of infection was the gastrointestinal and intra-abdominal tracts. Malignancy as comorbidity was present in 46.6% subjects. Significant risk factors for developing ESBL-producing E. coli bacteremia were history of antibiotic therapy and utilization of medical devices. The proportion of mortality in ESBL-producing E. coli bacteremia was 55.7% with age and sepsis as its independent risk factors. Conclusions: History of antibiotic therapy and utilization of medical devices were significant risk factors for ESBL-producing E. coli bacteremia. The proportion of mortality in ESBL-producing E. coli bacteremia patients was 55.7% with its independent risk factors being age and sepsis.