TOPLINE:

Younger individuals from ethnic minority groups, particularly women, experienced a disproportionate burden of Escherichia coli bacteraemia; antibiotic resistance was markedly higher among Asian individuals, and residing in a care home was linked to significantly increased rates of community-associated and resistant infections.

METHODOLOGY:

• Researchers retrospectively analysed national surveillance data to examine health inequalities among patients with E coli bacteraemia and associated factors.
• All cases of confirmed E coli bacteraemia (n = 242,604; 49.18% women) reported from public hospitals and laboratories in England between April 2018 and March 2024 were included.
• Bacteraemia cases were classified as healthcare-associated if the positive specimen was collected on or after the second day of admission or if the individual had been hospitalised within the preceding 28 days; all other cases were classified as community‑associated.
• Researchers assessed healthcare-associated vs community-associated cases and antibiotic-resistant vs antibiotic-susceptible cases, adjusting for factors including age, sex, socioeconomic deprivation, and residential type (care homes, private residences, and other settings).

TAKEAWAY:

• Asian and Black individuals had higher odds of resistant E coli bacteraemia than White individuals (odds ratios [ORs], 2.45 and 1.51, respectively; P < .001 for both).
• Women had 35% higher odds of community‑associated E coli bacteraemia than men (OR, 1.35; P < .001), and those aged 75 years or older had 31% higher odds than those aged 45-64 years (OR, 1.31; P < .001).
• E coli resistance was higher in Asian individuals and, to a lesser extent, in Black individuals than in White individuals: For second‑generation cephalosporins, resistance was 2.2- and 1.4-fold higher, respectively; for third-generation cephalosporins, resistance was 2.4- and 1.3-fold higher, respectively; for ciprofloxacin, resistance was 2.3- and 1.7-fold higher, respectively; and for co‑trimoxazole, resistance was 1.5- and 1.7-fold higher, respectively.
• Residing in a care home was associated with more than double the odds of resistant infection (OR, 2.28; P < .001) and 55% greater odds of community-associated infection (OR, 1.55; P < .001) compared with living in a private residence.

IN PRACTICE:

"A disproportionately higher burden of infection is observed in younger ethnic minority groups, particularly middle-aged females. Alarmingly, antibiotic-resistant E. coli is markedly elevated among Asian populations across several key agents, warranting investigation and tailored therapeutics," the authors wrote.

SOURCE:

The study was led by Dimple Y. Chudasama, UK Health Security Agency, London, England. It was published online on May 22, 2026, in Journal of Infection.

LIMITATIONS:

The study was limited by the area‑level analysis of the Index of Multiple Deprivation, potential misclassification of ethnicity, missing data, and the absence of information on comorbidities. Data on the source of infection were limited.

DISCLOSURES:

No specific funding beyond the core government funding was reported for this study. The authors disclosed having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.