M D Simmons1, S Daniel2, M Temple3. 1. Public Health Wales Microbiology, Carmarthen, UK. Electronic address: mike.simmons@wales.nhs.uk. 2. Hywel Dda University Health Board, Carmarthen, UK. 3. Penarth, Cardiff, UK.
Abstract
BACKGROUND: Escherichia coli bacteraemia reduction targets are challenging but, in West Wales, this was the key infection surrogate measure set by the local health board in 2013, prior to the introduction of a Welsh Government target. The initial plateau of cases was not maintained and prompted this review. AIM: To review all blood cultures submitted between 2002 and 2016, both positive and negative. METHODS: With access to a microbiology data warehouse in Wales, all blood culture results were collected, extracted to Excel tables and analysed using change point analysis. FINDINGS: Just under 200,000 blood culture results were examined. This study found an increase in blood culture submissions, but the positivity rate remained constant throughout the period and the increased number of E. coli reflected the increased number of blood cultures taken. This demonstrated the success of sepsis awareness and the use of sepsis bundles for rapid diagnosis and management. CONCLUSION: Success in one area (sepsis management) conflicts with 'failure' in reducing E. coli bacteraemia. It is argued that targets need to be considered carefully in the light of all available information, which have currently set the National Health Service up to fail.
BACKGROUND: Escherichia coli bacteraemia reduction targets are challenging but, in West Wales, this was the key infection surrogate measure set by the local health board in 2013, prior to the introduction of a Welsh Government target. The initial plateau of cases was not maintained and prompted this review. AIM: To review all blood cultures submitted between 2002 and 2016, both positive and negative. METHODS: With access to a microbiology data warehouse in Wales, all blood culture results were collected, extracted to Excel tables and analysed using change point analysis. FINDINGS: Just under 200,000 blood culture results were examined. This study found an increase in blood culture submissions, but the positivity rate remained constant throughout the period and the increased number of E. coli reflected the increased number of blood cultures taken. This demonstrated the success of sepsis awareness and the use of sepsis bundles for rapid diagnosis and management. CONCLUSION: Success in one area (sepsis management) conflicts with 'failure' in reducing E. coli bacteraemia. It is argued that targets need to be considered carefully in the light of all available information, which have currently set the National Health Service up to fail.