1457. Escherichia Coli Community Acquired Pneumonia
Session: Poster Abstract Session: Respiratory Infections: CAP
Friday, October 5, 2018
Room: S Poster Hall
Background: Escherichia coli (E.coli) has been thought to be an uncommon cause of community-acquired pneumonia (CAP). Large epidemiological data on E.coli CAP (E-CAP) and its comparison to pneumococcal CAP (P-CAP) are lacking.

Methods: A multi-center retrospective cohort study of adult patients (aged ≥ 18 years) admitted to 140 US hospitals with pneumonia and/or sepsis from 2010–2015, included in the Premier Research database. Patients with community-onset infection, antibiotic treatment beginning within the first 2 hospital days, and continued for at least 3 consecutive days were included. Patients were excluded if they had been transferred from another acute care facility, had cystic fibrosis, had a hospital length of stay of 1 day or less, co-existent urinary tract infection, gastrointestinal/ intra-abdominal infection, or simultaneous presence of other CAP pathogens. Pneumonia and sepsis were identified by ICD-9 codes.

Results: 13,165 patients met the inclusion criteria, of which 1247 had E.Coli CAP. Majority of patients with E-CAP were non-nursing home residents (90.2%, 1125/1247). 69.3% (864/1247) patients with E-CAP presented with ‘sepsis syndrome’ compared to only 48.1 % in other gram negative-CAP and 62.5 % in P-CAP. Aspiration pneumonia was diagnosed in 5.9% (73/1247) with E-CAP. Blood cultures were positive in 59.9 % (748/1247) of patients with E-CAP with 84.8% positivity in patients with sepsis syndrome. Patients with E-CAP compared to P-CAP were more likely to require ICU-level care (42.6% vs. 38.2 %), mechanical ventilation (19.3% vs. 15.7%), and require vasopressors (21% vs. 13.8%). In-hospital mortality was 14.8% in E-CAP compared to 7.4% in P-CAP. The median cost of hospitalization was great in E-CAP than P-CAP ($ 12,420.1 vs. $ 9857.5 ) Re-admission within 30 days was greater among patients with E-CAP than P-CAP (5.4% vs. 4%). 36.8 % of isolates were resistant to fluoroquinolones, 10.4% to ceftriaxone and 18.1% to aminoglycosides. Only 10/1247(0.8%) were multi-drug resistant.

Conclusion: E.coli is an important cause of severe CAP, with higher mortality, greater need for ICU-level care, and higher re-admission rates than patients with pneumococcal pneumonia. The rate of fluoroquinolone resistance was high and empiric quinolones should be used with caution for patients who are critically ill due to E-CAP

Teny Mathew John, MD1, Abhishek Deshpande, MD, PhD2, Sarah Haessler, MD3, Kyle Brizendine, MD4, Pei-Chun Yu, MS5, Peter Imrey, PhD5 and Michael B Rothberg, MD, MPH6, (1)Infectious Diseases, Cleveland Clinic, Cleveland, OH, (2)Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, (3)Infectious Diseases, Baystate Medical Center, Springfield, MA, (4)Infectious Disease, Cleveland Clinic, Cleveland, OH, (5)Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, (6)Medicine Institute Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH


T. M. John, None

A. Deshpande, 3M: Investigator , Research support . Clorox: Investigator and Speaker's Bureau , Research grant and Speaker honorarium . Merck: Investigator and Speaker's Bureau , Research support .

S. Haessler, None

K. Brizendine, None

P. C. Yu, None

P. Imrey, None

M. B. Rothberg, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.