INVASIVE Escherichia coli disease (IED) presents a significant public health concern, particularly in older adults undergoing elective urologic procedures. Extraintestinal pathogenic E. coli (ExPEC) strains can invade organs outside the gastrointestinal tract, leading to severe infections, including bacteremia, pyelonephritis, and meningitis. IED can lead to complications such as sepsis and septic shock, significantly increasing morbidity and mortality rates, especially in older patients. Studies suggest that elderly patients face a heightened risk of developing IED, with worse clinical outcomes compared to younger individuals.
Antibiotic prophylaxis is commonly recommended to prevent infections after urologic procedures. According to the 2019 American Urological Association (AUA) Best Practices Statement, antibiotic use should be considered when the potential benefits outweigh the risks. However, challenges persist in ensuring the optimal use of prophylactic antibiotics, given variations in patient conditions, comorbidities, and concerns around antimicrobial resistance. E. coli, responsible for 75–90% of infections after urologic procedures, remains a leading pathogen in these complications, with resistance to antibiotics becoming a growing concern, particularly among older patients.
The study aimed to assess the risk of IED following urologic procedures with or without antibiotic prophylaxis. It found that while patients receiving prophylaxis had a lower risk of infection compared to those without, the risk remained notably higher than in patients who did not undergo any urologic procedures. Patients who received antibiotic prophylaxis had up to a 25-fold higher risk of IED compared to controls. This highlights the need for more effective prevention strategies, as antibiotic prophylaxis, while useful, does not completely eliminate the risk.
The study’s findings emphasise the importance of improving strategies for preventing IED, particularly in older patients who face a higher burden of disease. New approaches such as personalised antibiotic prophylaxis based on preoperative cultures and the development of prophylactic vaccines could help mitigate the risks. Furthermore, increased adherence to guidelines and better compliance with antibiotic protocols are essential to improving outcomes and reducing the incidence of IED in this vulnerable population.
Reference
Neary MP et al. Risk of invasive Escherichia coli (E. coli) disease after elective urologic procedures among older adults in the united states. Infect Dis Ther. 2025;14(3):549-67.
