J Abernethy1, R Guy2, E A Sheridan3, S Hopkins4, M Kiernan5, M H Wilcox6, A P Johnson2, R Hope7. 1. National Infection Service, Public Health England, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK. 2. National Infection Service, Public Health England, London, UK. 3. National Infection Service, Public Health England, London, UK; Poole Hospital NHS Trust, Poole, UK. 4. Royal Free London NHS Foundation Trust, London, UK; Public Health Strategy, Public Health England, London, UK. 5. University of West London, Richard Wells Research Centre, London, UK. 6. Leeds Teaching Hospitals and University of Leeds, Leeds, UK. 7. National Infection Service, Public Health England, London, UK. Electronic address: Russell.hope@phe.gov.uk.
Abstract
BACKGROUND: Escherichia coli causes more than one-third of the bacteraemia cases in England each year, and the incidence of these infections is increasing. AIM: To determine the underlying risk factors associated with E. coli bacteraemia. METHODS: A three-month enhanced sentinel surveillance study involving 35 National Health Service hospitals was undertaken in the winter of 2012/13 to collect risk factor information and further details on the underlying source of infection to augment data already collected by the English national surveillance programme. Antimicrobial susceptibility results for E. coli isolated from blood and urine were also collected. FINDINGS: A total of 1731 cases of E. coli bacteraemia were included. The urogenital tract was the most frequently reported source of infection (51.2% of cases) with previous treatment for a urinary tract infection being the largest independent effect associated with this infection source. Half of all patients had previous healthcare exposure in the month prior to the bacteraemia with antimicrobial therapy and urinary catheterization being reported in one-third and one-fifth of these patients, respectively. Previous healthcare exposure was associated with a higher proportion of antibiotic non-susceptibility in the blood culture isolates (P=0.001). CONCLUSION: Analysis of risk factors suggests the potential benefit of community- and hospital-related interventions, especially the better use of urinary catheters and improved antibiotic management of urinary tract infections. As part of the latter strategy, antibiotic resistance profiles need to be closely monitored to ensure that treatment guidelines are up to date to limit inappropriate empiric therapy.
BACKGROUND:Escherichia coli causes more than one-third of the bacteraemia cases in England each year, and the incidence of these infections is increasing. AIM: To determine the underlying risk factors associated with E. coli bacteraemia. METHODS: A three-month enhanced sentinel surveillance study involving 35 National Health Service hospitals was undertaken in the winter of 2012/13 to collect risk factor information and further details on the underlying source of infection to augment data already collected by the English national surveillance programme. Antimicrobial susceptibility results for E. coli isolated from blood and urine were also collected. FINDINGS: A total of 1731 cases of E. coli bacteraemia were included. The urogenital tract was the most frequently reported source of infection (51.2% of cases) with previous treatment for a urinary tract infection being the largest independent effect associated with this infection source. Half of all patients had previous healthcare exposure in the month prior to the bacteraemia with antimicrobial therapy and urinary catheterization being reported in one-third and one-fifth of these patients, respectively. Previous healthcare exposure was associated with a higher proportion of antibiotic non-susceptibility in the blood culture isolates (P=0.001). CONCLUSION: Analysis of risk factors suggests the potential benefit of community- and hospital-related interventions, especially the better use of urinary catheters and improved antibiotic management of urinary tract infections. As part of the latter strategy, antibiotic resistance profiles need to be closely monitored to ensure that treatment guidelines are up to date to limit inappropriate empiric therapy.
Authors: Athena P Kourtis; Edward A Sheriff; Lindsey M Weiner-Lastinger; Kim Elmore; Leigh Ellyn Preston; Margaret Dudeck; L Clifford McDonald Journal: Clin Infect Dis Date: 2021-12-06 Impact factor: 20.999
Authors: Karina-Doris Vihta; Nicole Stoesser; Martin J Llewelyn; T Phuong Quan; Tim Davies; Nicola J Fawcett; Laura Dunn; Katie Jeffery; Chris C Butler; Gail Hayward; Monique Andersson; Marcus Morgan; Sarah Oakley; Amy Mason; Susan Hopkins; David H Wyllie; Derrick W Crook; Mark H Wilcox; Alan P Johnson; Tim E A Peto; A Sarah Walker Journal: Lancet Infect Dis Date: 2018-08-17 Impact factor: 25.071