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.
Bibliographical noteFunding Information:
M.H.W. has received: consulting fees from Actelion , Astellas , Astra-Zeneca , Bayer , Cerexa , Cubist , Durata , The Medicines Company , MedImmune , Merck , Motif Biosciences , Nabriva , Optimer , Paratek , Pfizer , Roche , Sanofi-Pasteur , Seres , Summit , and Synthetic Biologics ; lecture fees from Abbott , Alere , Astellas , Astra-Zeneca , Pfizer & Roche ; and grant support from Abbott , Actelion , Astellas , bioMérieux , Cubist , Da Volterra , Merck , Paratek , Pfizer , Sanofi-Pasteur and Summit . S.H. is affiliated with the National Institute for Health Research Health Protection Research Units (NIHR HPRU) in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London and University of Oxford in partnership with Public Health England (PHE). The other authors have nothing to disclose. The views expressed in this article are those of the authors and not necessarily shared by their organizations or affiliates.
This work was funded in its entirety by Public Health England .
- Risk factors
- Urinary tract infection