TY - JOUR
T1 - Community-acquired Escherichia coli bacteremia after age 50 and subsequent incidence of a cancer diagnosis
T2 - a Danish population-based cohort study
AU - Søgaard, Kirstine K
AU - Veres, Katalin
AU - Vandenbroucke-Grauls, Christina Mje
AU - Vandenbroucke, Jan P
AU - Sorensen, Henrik Toft
AU - Schønheyder, Henrik C
PY - 2020/12
Y1 - 2020/12
N2 - BACKGROUND: Community-acquired bacteremia (CAB) with Escherichia coli may signal occult cancer. This might differ between phylogenetic groups.METHODS: We conducted a population-based cohort study in Northern Denmark (1994-2013) to examine whether E. coli CAB after age 50 is associated with incident cancer. We followed patients from their bacteremia diagnosis date to identify subsequent gastrointestinal, hepatobiliary, and urinary tract cancer diagnoses. We calculated 1- and 5-year cumulative cancer incidence. We compared the observed incidence to that expected based on national cancer incidence rates, and computed standardized incidence ratios (SIRs) at 0-<1 year and ≥1 year. In a subcohort, we assessed the prevalence of phylogenetic groups.RESULTS: Among 2735 patients with E. coli CAB, 173 later were diagnosed with cancer. The 1-year cumulative incidence of a gastrointestinal or hepatobiliary tract cancer was 1.9% and the 0-<1-year SIR was 5.44 (95% CI:4.06-7.14). For urinary tract cancer, the corresponding estimates were 1.0% and 3.41 (95% CI:2.27-4.93). All individual cancers occurred more often than expected during the first year following E. coli CAB, but thereafter the relative risks declined towards unity. Still, the ≥1-year SIR for colorectal cancer remained 1.4-fold elevated and the SIR for liver, pancreas, gallbladder and biliary tract cancer was 2-fold elevated. The prevalence of phylogenetic groups was similar among patients with and without cancer.CONCLUSIONS: Gastrointestinal, hepatobiliary, and urinary tract cancer may debut with E. coli CAB.IMPACT: Owing to the high incidence of E. coli bacteremia, cancers missed at the time of bacteremia diagnosis represent a clinically significant problem.
AB - BACKGROUND: Community-acquired bacteremia (CAB) with Escherichia coli may signal occult cancer. This might differ between phylogenetic groups.METHODS: We conducted a population-based cohort study in Northern Denmark (1994-2013) to examine whether E. coli CAB after age 50 is associated with incident cancer. We followed patients from their bacteremia diagnosis date to identify subsequent gastrointestinal, hepatobiliary, and urinary tract cancer diagnoses. We calculated 1- and 5-year cumulative cancer incidence. We compared the observed incidence to that expected based on national cancer incidence rates, and computed standardized incidence ratios (SIRs) at 0-<1 year and ≥1 year. In a subcohort, we assessed the prevalence of phylogenetic groups.RESULTS: Among 2735 patients with E. coli CAB, 173 later were diagnosed with cancer. The 1-year cumulative incidence of a gastrointestinal or hepatobiliary tract cancer was 1.9% and the 0-<1-year SIR was 5.44 (95% CI:4.06-7.14). For urinary tract cancer, the corresponding estimates were 1.0% and 3.41 (95% CI:2.27-4.93). All individual cancers occurred more often than expected during the first year following E. coli CAB, but thereafter the relative risks declined towards unity. Still, the ≥1-year SIR for colorectal cancer remained 1.4-fold elevated and the SIR for liver, pancreas, gallbladder and biliary tract cancer was 2-fold elevated. The prevalence of phylogenetic groups was similar among patients with and without cancer.CONCLUSIONS: Gastrointestinal, hepatobiliary, and urinary tract cancer may debut with E. coli CAB.IMPACT: Owing to the high incidence of E. coli bacteremia, cancers missed at the time of bacteremia diagnosis represent a clinically significant problem.
U2 - 10.1158/1055-9965.EPI-20-0705
DO - 10.1158/1055-9965.EPI-20-0705
M3 - Journal article
C2 - 32998944
SN - 1055-9965
VL - 29
SP - 2626
EP - 2632
JO - Cancer Epidemiology, Biomarkers & Prevention
JF - Cancer Epidemiology, Biomarkers & Prevention
IS - 12
ER -