Medical and economic impact of extraintestinal infections due to Escherichia coli: focus on an increasingly important endemic problem.

Escherichia coli is probably the best-known bacterial species and one of the most frequently isolated organisms from clinical specimens. Despite this, underappreciation and misunderstandings exist among medical professionals and the lay public alike regarding E. coli as an extraintestinal pathogen. Underappreciated features include (i) the wide variety of extraintestinal infections E. coli can cause, (ii) the high incidence and associated morbidity, mortality, and costs of these diverse clinical syndromes, (iii) the pathogenic potential of different groups of E. coli strains for causing intestinal versus extraintestinal disease, and (iv) increasing antimicrobial resistance. In this era in which health news often sensationalizes uncommon infection syndromes or pathogens, the strains of E. coli that cause extraintestinal infection are an increasingly important endemic problem and underappreciated "killers". Billions of health care dollars, millions of work days, and hundreds of thousands of lives are lost each year to extraintestinal infections due to E. coli. New treatments and prevention measures will be needed for improved outcomes and a diminished disease burden.

[1]  J. R. Johnson,et al.  Widespread distribution of urinary tract infections caused by a multidrug-resistant Escherichia coli clonal group. , 2001, The New England journal of medicine.

[2]  D. Schwartz,et al.  Reappraisal of community-acquired bacteremia: a proposal of a new classification for the spectrum of acquisition of bacteremia. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[3]  R A Weinstein,et al.  Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. , 1999, JAMA.

[4]  H. Mobley,et al.  Urinary tract infections : molecular pathogenesis and clinical management , 1996 .

[5]  M. McBean,et al.  Increasing rates of hospitalization due to septicemia in the US elderly population, 1986-1997. , 2001, The Journal of infectious diseases.

[6]  A. Stapleton,et al.  Hemolytic-uremic syndrome in a six-year-old girl after a urinary tract infection with Shiga-toxin-producing Escherichia coli O103:H2. , 1996, The New England journal of medicine.

[7]  P. Coll,et al.  Escherichia coli capsular polysaccharide and spontaneous bacterial peritonitis in cirrhosis , 1995, Hepatology.

[8]  W. Poole,et al.  Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. , 2002, The New England journal of medicine.

[9]  Ismail Nh,et al.  BACTERAEMIA IN THE ELDERLY , 1997 .

[10]  E. McCarthy Inpatient utilization of short-stay hospitals, by diagnosis. , 1982, Vital and health statistics. Series 13, Data from the National Health Survey.

[11]  S. Langermann,et al.  Prevention of mucosal Escherichia coli infection by FimH-adhesin-based systemic vaccination. , 1997, Science.

[12]  J. Louvois Acute bacterial meningitis in the newborn , 1994 .

[13]  T. Hooton,et al.  Diagnosis and treatment of uncomplicated urinary tract infection. , 1997, Infectious disease clinics of North America.

[14]  R. Wenzel,et al.  Hospital-acquired pneumonia: Overview of the current state of the art for prevention and control , 2005, European Journal of Clinical Microbiology and Infectious Diseases.

[15]  Jacques Elion,et al.  The Link between Phylogeny and Virulence inEscherichia coli Extraintestinal Infection , 1999, Infection and Immunity.

[16]  U. Reinhardt,et al.  The world health report 2000 - Health systems: improving performance , 2000 .

[17]  G. Clermont,et al.  Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care , 2001, Critical care medicine.

[18]  Schappert Sm National Ambulatory Medical Care Survey: 1992 summary. , 1994, Advance data.

[19]  S. L. Murphy Deaths: final data for 1998. , 2000, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[20]  D. Nash,et al.  Urinary tract infection: economic considerations. , 1991, The Medical clinics of North America.

[21]  D. Raahave,et al.  Survival of patients with surgical wound infection: A case‐control study of common surgical interventions , 1995, The British journal of surgery.

[22]  D. Scholes,et al.  Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. , 1999, JAMA.

[23]  J. Verhoef,et al.  Frequency of Isolation of Pathogens from Bloodstream, Nosocomial Pneumonia, Skin and Soft Tissue, and Urinary Tract Infections Occurring in European Patients , 2001, European Journal of Clinical Microbiology and Infectious Diseases.

[24]  W. Stamm Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. , 1991, The American journal of medicine.

[25]  James P. Nataro,et al.  Diarrheagenic Escherichia coli , 1998, Clinical Microbiology Reviews.

[26]  A. Pauwels,et al.  Bacterial meningitis in cirrhosis: review of 16 cases. , 1997, Journal of hepatology.

[27]  R. Gaynes,et al.  An overview of nosocomial infections, including the role of the microbiology laboratory , 1993, Clinical Microbiology Reviews.

[28]  J. R. Johnson,et al.  Extended virulence genotypes of Escherichia coli strains from patients with urosepsis in relation to phylogeny and host compromise. , 2000, The Journal of infectious diseases.

[29]  S. Franco,et al.  Long-term outcome of neonatal meningitis. , 1992, American journal of diseases of children.

[30]  S. C. Park,et al.  Bacteremia due to quinolone-resistant Escherichia coli in a teaching hospital in South Korea. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[31]  W. Jarvis,et al.  Selected Aspects of the Socioeconomic Impact of Nosocomial Infections: Morbidity, Mortality, Cost, and Prevention , 1996, Infection Control & Hospital Epidemiology.

[32]  D. Drekonja,et al.  Urinary Tract Infections , 2003 .

[33]  J. R. Johnson,et al.  Proposal for a new inclusive designation for extraintestinal pathogenic isolates of Escherichia coli: ExPEC. , 2000, The Journal of infectious diseases.

[34]  W E Wilkinson,et al.  The Impact of Surgical-Site Infections in the 1990s: Attributable Mortality, Excess Length of Hospitalization, And Extra Costs , 1999, Infection Control & Hospital Epidemiology.

[35]  G. Guyatt,et al.  A Comparison of Sucralfate and Ranitidine for the Prevention of Upper Gastrointestinal Bleeding in Patients Requiring Mechanical Ventilation , 1999 .

[36]  B. Foxman,et al.  Epidemiology of urinary tract infection: I. Diaphragm use and sexual intercourse. , 1985, American journal of public health.

[37]  D. Craven,et al.  Nosocomial pneumonia in the 1990s: update of epidemiology and risk factors. , 1990, Seminars in respiratory infections.

[38]  J. Reuning-Scherer,et al.  Comparison of Ciprofloxacin (7 Days) and Trimethoprim-Sulfamethoxazole (14 Days) for Acute Uncomplicated Pyelonephritis in Women , 2000 .

[39]  Ronald N. Jones,et al.  Four-year evaluation of frequency of occurrence and antimicrobial susceptibility patterns of bacteria from bloodstream infections in Latin American medical centers. , 2002, Diagnostic microbiology and infectious disease.

[40]  S. Saint Clinical and economic consequences of nosocomial catheter-related bacteriuria. , 2000, American journal of infection control.

[41]  J. Sobel,et al.  Urinary tract infection: self-reported incidence and associated costs. , 2000, Annals of epidemiology.

[42]  G. Gibbons,et al.  Use of ampicillin/sulbactam versus imipenem/cilastatin in the treatment of limb-threatening foot infections in diabetic patients. , 1994, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[43]  A. Miniño,et al.  Deaths: preliminary data for 2000. , 2001, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[44]  T. Russo,et al.  Uropathogenic Escherichia coli as agents of diverse non-urinary tract extraintestinal infections. , 2002, The Journal of infectious diseases.

[45]  H. J. Kolmos,et al.  Bacteraemia due to Escherichia coli in a Danish university hospital, 1986-1990. , 1995, Scandinavian journal of infectious diseases.

[46]  M. Kuskowski,et al.  Epidemiological correlates of virulence genotype and phylogenetic background among Escherichia coli blood isolates from adults with diverse-source bacteremia. , 2002, The Journal of infectious diseases.

[47]  J Ean,et al.  Efficacy and safety of recombinant human activated protein C for severe sepsis. , 2001, The New England journal of medicine.

[48]  M. Saccente PERIPROSTHETIC JOINT INFECTIONS : A REVIEW FOR CLINICIANS , 1998 .

[49]  R. Muder Pneumonia in residents of long-term care facilities: epidemiology, etiology, management, and prevention. , 1998, The American journal of medicine.

[50]  G. Guyatt,et al.  A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. , 1998, The New England journal of medicine.

[51]  A. D. Nogare Nosocomial pneumonia in the medical and surgical patient: Risk Factors and Primary Management , 1994 .

[52]  I. Phillips,et al.  Bacteremia due to Escherichia coli: a study of 861 episodes. , 1990, Reviews of infectious diseases.

[53]  B. K. Jain,et al.  Bacteriology of burns. , 1998, Burns : journal of the International Society for Burn Injuries.

[54]  N. Radin,et al.  Epithelial glucosphingolipid expression as a determinant of bacterial adherence and cytokine production , 1994, Infection and immunity.

[55]  T. Hooton,et al.  Increasing Antimicrobial Resistance and the Management of Uncomplicated Community-Acquired Urinary Tract Infections , 2001, Annals of Internal Medicine.

[56]  P. Collignon,et al.  Bacteraemia and Fungaemia in an Australian General Hospital — Associations and Outcomes , 1993, The Medical journal of Australia.

[57]  D. Zoutman,et al.  Total and Attributable Costs of Surgical-Wound Infections at a Canadian Tertiary-Care Center , 1998, Infection Control & Hospital Epidemiology.

[58]  E. Sullivan,et al.  Survey of blood cultures from five community hospitals in south-western Sydney, Australia, 1993-1994. , 1999, Australian and New Zealand journal of medicine.

[59]  P. Willcox,et al.  Community-acquired bacteraemia; a prospective survey of 239 cases. , 1988, The Quarterly journal of medicine.

[60]  R. A. Myers,et al.  The microbiology of necrotizing soft tissue infections. , 2000, American journal of surgery.

[61]  A. Coldman,et al.  A three-year study of positive blood cultures, with emphasis on prognosis. , 1991, Reviews of infectious diseases.