Abstract

Mortality and Length of Stay Associated With Community-Acquired Escherichia coli and Staphylococcus aureus Bloodstream Infections: An Observational Study in 9 Low- and Middle-Income Countries

Hopkins, J. Tosas-Auguet, O. Waithira, N. Painter, C. Ling, C. L. Roberts, T. Miliya, T. Obeng-Nkrumah, N. Opintan, J. A. Abbeyquaye, E. P. Hamers, R. L. Saharman, Y. R. Sinto, R. Karyanti, M. R. Ibrahim, R. F. Akech, S. O. Ashley, E. A. Douangnouvong, A. Choumlivong, K. Feasey, N. A. Kululanga, D. Lissauer, S. Karkey, A. Kunwar, N. Erakhaiwu, J. E. Okeke, I. N. Adebiyi, I. Adekanmbi, O. A. Oduola, A. B. Ogunbosi, B. O. Ojifinni, K. A. Tongo, O. O. Ude, I. A. Aboderin, A. O. Adekanle, O. Adeyemo, A. T. Edward, S. S. Osagie, U. Nguyen, H. T. Pham, T. N. Van Tran, G. Hoang, H. T. L. Trinh, T. H. van Doorn, H. R. Turner, P. Lee, S. J.
Clin Infect Dis. 2026;

Permanent descriptor

https://doi.org/10.1093/cid/ciag275

BACKGROUND: Antimicrobial resistance disproportionally affects low- and middle-income countries. We calculated the burden of resistant and susceptible Escherichia coli and Staphylococcus aureus bloodstream infections (BSIs) in ACORN2, a prospective clinical surveillance study in adults and children. METHODS: Patients with culture-confirmed community-acquired susceptible and resistant E. coli (third-generation cephalosporin susceptible [3GC-S] and resistant [3GC-R]) and S. aureus (methicillin-resistant [MRSA] and methicillin-susceptible [MSSA]) BSIs were compared against blood culture-negative patients (controls). Cause-specific hazard ratios (HRs) were calculated for competing events of in-hospital mortality and discharge alive. Length of hospital stay (LOS) was calculated. RESULTS: From 22 802 blood cultures taken, there were 329 E. coli (177 [53.8%] 3GC-R) and 363 S. aureus (132 [36.4%] MRSA) BSIs. In-hospital mortality was 8.4% for controls, 20.1% for E. coli (20.3% 3GC-R; 19.7% 3GC-S), and 13.1% for S. aureus (12.2% MRSA; 13.7% MSSA). 3GC-S but not 3GC-R E. coli BSI cases had higher adjusted hazard of death than controls (HRs, 1.73 [95% confidence interval CI, 1.20-2.49] and 1.38 [95% CI, .99-1.94]); risk of dying was the same for 3GC-S compared with 3GC-R infections (P = .882). Neither MSSA nor MRSA BSI patients were more likely to die than controls (HRs, 1.33 [95% CI, .91-1.93] and 1.00 [95% CI, .61-1.66]) nor MSSA versus MRSA (P = .891). The hazard of discharge alive for both resistant and susceptible S. aureus and E. coli decreased significantly when compared with controls. LOS was 2 (95% CI, 0-3) days and 1 (95% CI, -1 to 3) day longer for resistant compared with susceptible infections, for E. coli and S. aureus. CONCLUSIONS: Antimicrobial-resistant infections were not associated with increased mortality in ACORN2. Drug-resistant BSI had longer LOS compared with susceptible infections, but CIs encompassed 0 days.