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Reducing Escherichia coli bacteraemia associated with catheter-associated urinary tract infections in the secondary care setting

Published:December 01, 2017DOI:https://doi.org/10.1016/j.jhin.2017.11.018
      Escherichia coli is the leading cause of bloodstream infections (BSIs) in England, with sustained annual increases [
      • Abernethy J.
      • Guy R.
      • Sheridan E.A.
      • Hopkins S.
      • Kiernan M.
      • Wilcox M.H.
      • et al.
      E. coli Bacteraemia Sentinel Surveillance Group
      Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme.
      ]. Thirty-day all-cause mortality in England for E. coli BSI was recently estimated as 18.2%, equating to 5220 deaths annually [
      • Abernethy J.K.
      • Johnson A.P.
      • Guy R.
      • Hinton N.
      • Sheridan E.A.
      • Hope R.J.
      Thirty day all-cause mortality in patients with Escherichia coli bacteraemia in England.
      ]. Year-on-year increases in E. coli BSI have also been reported across Europe [
      • Abernethy J.
      • Guy R.
      • Sheridan E.A.
      • Hopkins S.
      • Kiernan M.
      • Wilcox M.H.
      • et al.
      E. coli Bacteraemia Sentinel Surveillance Group
      Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme.
      ,
      • Gagliotti C.
      • Balode A.
      • Baquero F.
      • Degener J.
      • Grundmann H.
      • Gür D.
      • et al.
      EARS-Net Participants (Disease Specific Contact Points for AMR)
      Escherichia coli and Staphylococcus aureus: bad news and good news from the European Antimicrobial Resistance Surveillance Network (EARS-Net, formerly EARSS), 2002 to 2009.
      ], and in the USA, E. coli is the most common and second most common cause of community- and hospital-acquired BSI, respectively [
      • Bou-Antoun S.
      • Davies J.
      • Guy R.
      • Johnson A.P.
      • Sheridan E.A.
      • Hope R.F.
      Descriptive epidemiology of Escherichia coli bacteraemia in England, April 2012 to March 2014.
      ,
      • De Kraker M.E.
      • Davey P.G.
      • Grundmann H.
      Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe.
      ]. Targeted interventions may reduce E. coli BSI [
      • Abernethy J.
      • Guy R.
      • Sheridan E.A.
      • Hopkins S.
      • Kiernan M.
      • Wilcox M.H.
      • et al.
      E. coli Bacteraemia Sentinel Surveillance Group
      Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme.
      ] but there is contention whether this can be achieved for an infection that is often endogenous [
      • Melzer M.
      • Welch C.
      Is Escherichia coli bacteraemia preventable?.
      ,
      • Underwood J.
      • Klein J.L.
      • Newsholme W.
      Escherichia coli bacteraemia: how preventable is it?.
      ]. A sentinel surveillance scheme in England examined risk factors for E. coli BSI in the community and hospitals [
      • Abernethy J.
      • Guy R.
      • Sheridan E.A.
      • Hopkins S.
      • Kiernan M.
      • Wilcox M.H.
      • et al.
      E. coli Bacteraemia Sentinel Surveillance Group
      Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme.
      ,

      Public Health England. Escherichia coli (E. coli) bacteraemia: monthly data by NHS acute trust. London: PHE; last updated 7 December 2016. Available at: https://www.gov.uk/government/statistics/escherichia-coli-e-coli-bacteraemia-monthly-data-by-nhs-acutetrust [last accessed December 2016].

      ]. The urogenital tract was the most common source of infection (51.2%); key secondary risk factors included prior hospitalization, antimicrobial therapy and urinary catheterization [
      • Abernethy J.
      • Guy R.
      • Sheridan E.A.
      • Hopkins S.
      • Kiernan M.
      • Wilcox M.H.
      • et al.
      E. coli Bacteraemia Sentinel Surveillance Group
      Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme.
      ,
      • Abernethy J.K.
      • Johnson A.P.
      • Guy R.
      • Hinton N.
      • Sheridan E.A.
      • Hope R.J.
      Thirty day all-cause mortality in patients with Escherichia coli bacteraemia in England.
      ,
      • Bou-Antoun S.
      • Davies J.
      • Guy R.
      • Johnson A.P.
      • Sheridan E.A.
      • Hope R.F.
      Descriptive epidemiology of Escherichia coli bacteraemia in England, April 2012 to March 2014.
      ]. The authors undertake postinfection reviews (PIRs) of all catheter-associated urinary tract infections (CAUTIs) identified by the NHS Safety Thermometer tool. This tool is used for a national Commissioning for Quality and Innovation incentive scheme that incentivizes English hospitals to take snapshot measures of four common harms, including CAUTI. PIRs are also undertaken for all healthcare-associated (post day 0 plus 1) E. coli BSI where the source of infection is suspected to be CAUTI. The authors' experience of this process is presented below.
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