Risk Factors and Clinical Impact of Extended-Spectrum Beta-Lactamase (ESBL)-Producing Escherichia coli Bacteremia Among Hospitalized Patients

<b>Background/Objectives</b>: The prevalence of ESBL-producing <i>Escherichia coli</i> (<i>E. coli</i>) has increased significantly, impacting prognoses due to delayed or limited treatment options. We aimed to determine the demographic patterns, risk factors, and clinical outcomes of ESBL-producing <i>E. coli</i> in a top-referral hospital in Indonesia. <b>Methods</b>: This study was observational in design and focused on hospitalized patients with bacteremia due to <i>E. coli</i> during 2022-2024. <b>Results</b>: We identified 224 patients during the study period. The median of length of stay was 7 (3-13) days. Mortality occurred in 149 (66.55%) patients, and there was no difference in the mortality between patients with ESBL <i>E. coli</i> and those with non-ESBL <i>E. coli</i>. The severity of illness, as defined by the Pitt bacteremia score (PBS), was higher in the ESBL <i>E. coli</i> group. Urinary tract infection (UTI), previous antibiotic use, and central venous catheter (CVC) insertion were independent risk factors for bacteremia due to ESBL <i>E. coli</i> bacteremia. Male gender, shorter length of stay (LOS), solid tumor, pneumonia, mechanical ventilation, CVC insertion, inappropriate initial antibiotic therapy (IIAT), and sequential organ failure assessment (SOFA) score were risk factors for mortality in bacteremia caused by <i>E. coli</i>, including both ESBL and non-ESBL producers. Male gender, shorter LOS, CVC usage, and SOFA score were independent risk factors for mortality in bacteremia due to ESBL <i>E. coli</i>. <b>Conclusions</b>: ESBL-producing <i>E. coli</i> increases the severity of bacteremia. Recognizing patients at high risk for ESBL-producing <i>E. coli</i> infections is crucial for initiating appropriate empirical antibiotic treatment targeting ESBL-producing pathogens.