Objective: To describe medical resource utilization and costs associated with invasive extraintestinal pathogenic E. coli disease (IED) in older adults in the US.

Methods: Patients ≥60 years old with ≥1 IED hospital encounter were identified from the Premier Healthcare Database (10/01/2015-03/31/2020). The index encounter was defined as the first encounter with a positive E. coli culture in a normally sterile site (Group 1) or positive E. coli culture in urine with signs of sepsis (Group 2). Encounters with a positive culture from other bacteria or fungal pathogens were excluded. Outcomes were descriptively reported during the index encounter and over the subsequent year (post-index period). Medical resource utilization and costs included inpatient admissions and outpatient hospital services; costs were reported from a hospital’s perspective in 2021 USD.

Results: A total of 19,773 patients with IED were identified (Group 1: 51.8%; Group 2: 48.2%). Mean age was 76.8 years and 67.4% were female. Most index encounters had community-onset (94.3%) and led to inpatient hospitalization (96.5%; mean duration: 6.9 days), while 32.4% required transfer to an intensive care unit admission (mean duration: 3.7 days). In-hospital fatality rate was 6.8% during the index encounter and reached 10.9% at 1-year post-index. During the post-index period, 2.4% of patients had an IED recurrence and 36.8% had ≥1 all-cause hospitalization. Average all-cause medical costs amounted to $16,760 during the index encounter and $10,942 during the post-index period. Compared to Group 1, IED encounters from Group 2 were associated with higher all-cause medical costs during the index encounter ($18,536 vs $15,105, p<0.001); this difference was not statistically significant during the post-index period ($11,754 vs $10,186, p=0.204).

Conclusion: IED is associated with substantial clinical and economic burden both during the initial encounter and over the following year, highlighting the need and potential benefits of preventive management of IED.