Impact of Invasive Escherichia Coli Disease on Clinical Outcomes and Medical Resource Utilization Among Asian Patients in the United States

Chao Zhuo; Bo Zheng; Kittima Wattanakamolkul; Yoshikazu Nakayama; Martin Cloutier; Marjolaine Gauthier-Loiselle; Jun Feng; David Wu; Maureen P Neary; Jeroen Geurtsen; Antoine C El Khoury; Yoshiaki Gu

doi:10.1007/s40121-023-00911-0

Impact of Invasive Escherichia Coli Disease on Clinical Outcomes and Medical Resource Utilization Among Asian Patients in the United States

Infect Dis Ther. 2024 Feb;13(2):313-328. doi: 10.1007/s40121-023-00911-0. Epub 2024 Jan 24.

Authors

Affiliations

¹ Department of Infectious Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
² Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, People's Republic of China.
³ Janssen Pharmaceutical K.K, Tokyo, Japan.
⁴ Health Economics and Outcomes Research, Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada.
⁵ Health Economics and Outcomes Research, Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada. Marjolaine.Gauthier-Loiselle@analysisgroup.com.
⁶ Johnson and Johnson International (Singapore) PTE. Ltd, Singapore, Singapore.
⁷ Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
⁸ Janssen Global Services, LLC, 1000 U.S. Route 202 South, Raritan, NJ, 08869, USA.
⁹ Bacterial Vaccines Research and Early Development, Janssen Vaccines and Prevention BV, Leiden, 2333 CN, The Netherlands.
¹⁰ Department of Infectious Diseases, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.

Abstract

Introduction: Invasive Escherichia coli disease (IED) can lead to sepsis and death and is associated with a substantial burden. Yet, there is scarce information on the burden of IED in Asian patients.

Methods: This retrospective study used US hospital data from the PINC AI™ Healthcare database (October 2015-March 2020) to identify IED cases among patients aged ≥ 60 years. IED was defined as a positive E. coli culture in blood or other normally sterile body site (group 1 IED) or positive culture of E. coli in urine with signs of sepsis (group 2 IED). Eligible patients with IED were classified into Asian and non-Asian cohorts based on their reported race. Entropy balancing was used to create cohorts with similar characteristics. Outcomes following IED were descriptively reported in the balanced cohorts.

Results: A total of 646 Asian and 19,127 non-Asian patients with IED were included (median age 79 years; 68% female after balancing). For both cohorts, most IED encounters had community-onset (> 95%) and required hospitalization (Asian 96%, mean duration 6.9 days; non-Asian 95%, mean duration 6.8 days), with frequent admission to intensive care (Asian 35%, mean duration 3.3 days; non-Asian 34%, mean duration 3.5 days), all standardized differences [SD] < 0.20. Compared to non-Asian patients, Asian patients were more likely to be discharged home (54% vs. 43%; SD = 0.22), and less likely to be discharged to a skilled nursing facility (24% vs. 31%; SD = 0.16). In-hospital fatality rates during the IED encounter were similar across cohorts (Asian 9%, non-Asian 10%; SD = 0.01). Most E. coli isolates showed resistance to ≥ 1 antibiotic (Asian 61%; non-Asian 64%) and 36% to ≥ 3 antibiotic classes (all SD < 0.20).

Conclusion: IED is associated with a substantial burden, including need for intensive care and considerable mortality, in Asian patients in the USA that is consistent with that observed for non-Asian patients.

Keywords: E. coli; Antibiotic resistance; Asian; Burden of illness; Invasive E. coli disease; Medical resource utilization; Sepsis.