title: Clinical significance of healthcare-associated infections in community-onset Escherichia coli bacteraemia.
abstract: BACKGROUND
  The increasing antimicrobial resistance of Escherichia coli infection is of great concern, even for community-onset infections.
  
  
  METHODS
  We conducted a retrospective cohort study of patients with E. coli bacteraemia who visited the emergency department of the Samsung Medical Center from February 2002 to December 2005 to identify the risk factors for mortality and association between healthcare-associated (HCA) infection and mortality. We classified community-onset E. coli bacteraemia into community-acquired (CA) and HCA infections.
  
  
  RESULTS
  A total of 508 patients with E. coli bacteraemia were enrolled (mean age, 61.8 +/- 14.3 years; male/female, 191:317). The HCA E. coli bacteraemia had significantly higher severity of illness and higher antimicrobial resistance rate than CA bacteraemia. The overall 30-day mortality rate was 13.6% (69/508) and the mortality of HCA infections was significantly higher than that of CA infections (26.4% versus 9.6%, P < 0.001). In multivariate analysis, high Charlson's co-morbidity index (OR 4.84, 95% CI 2.14-10.95, P < 0.001), high Pitt bacteraemia score (OR 32.03, 95% CI 13.08-74.43, P < 0.001), presentation with acute renal failure (OR 4.11, 95% CI 1.90-8.89, P < 0.001) and HCA bacteraemia (OR 2.34, 95% CI 1.09-5.01, P = 0.030) were found to be the significant risk factors for 30-day mortality in E. coli bacteraemia.
  
  
  CONCLUSIONS
  The mortality rate of HCA E. coli bacteraemia was higher than twice that of CA bacteraemia and HCA bacteraemia was one of the significant risk factors for mortality, even after adjusting for a large number of potential confounders.
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 ILwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
authors.forename: Hae Suk
authors.initials: HS
authors.lastname: Cheong
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Kwon
authors.forename: Sang Tack
authors.initials: ST
authors.lastname: Heo
authors.forename: Yu Mi
authors.initials: YM
authors.lastname: Wi
authors.forename: Eun Seok
authors.initials: ES
authors.lastname: Kim
authors.forename: Jin Seo
authors.initials: JS
authors.lastname: Lee
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Ko
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Nam Yong
authors.initials: NY
authors.lastname: Lee
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000382:microbiology / Q000401:mortality*; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality*; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000382:microbiology / Q000401:mortality*; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents