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Enhanced surveillance of Escherichia coli healthcare-associated bloodstream infections – how many are preventable?

      Concern about the increasing incidence of Gram-negative bloodstream infection (GNBSI) has now led to a national ambition in England to halve the numbers of healthcare-associated (HA) GNBSI by 2021 [
      • Wilcox M.H.
      The start of another infection prevention learning curve; reducing healthcare-associated Gram-negative infections.
      ,
      • Davies J.
      • Johnson A.P.
      • Hope R.
      Identifying hospital-onset Escherichia coli bacteraemia cases from English mandatory surveillance: the case for applying a two-day post-admission rule.
      ]. A new definition of HA-GNBSI has also been proposed, based, in part, on the findings of the 2012 three-month enhanced surveillance study of 1731 episodes of Escherichia coli bloodstream infection (BSI) [
      • NHS Improvement
      Guidance on the definition of healthcare associated Gram-negative bloodstream infections.
      ,
      • Abernethy J.
      • Guy R.
      • Sheridan E.A.
      • Hopkins S.
      • Kiernan M.
      • Wilcox M.H.
      • et al.
      Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme.
      ]. Nottingham participated in the 2012 study, contributing 167 episodes of E. coli BSI. Of these, 123 (74%) were of community onset. Not surprisingly, urinary tract infection (UTI) and biliary sepsis were the most frequent underlying sources for the BSI. The conclusion at that time from our in-depth multi-disciplinary review of each case was that, at best, only 18% of the Nottingham cases might have been preventable.
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      References

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        The start of another infection prevention learning curve; reducing healthcare-associated Gram-negative infections.
        J Hosp Infect. 2017; 97: 205-206
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        Identifying hospital-onset Escherichia coli bacteraemia cases from English mandatory surveillance: the case for applying a two-day post-admission rule.
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        • NHS Improvement
        Guidance on the definition of healthcare associated Gram-negative bloodstream infections.
        July 2017 (Available at:) ([last accessed May 2018])
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        • et al.
        Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme.
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