Strategy to reduce E. coli bacteraemia based on cohort data from a London teaching hospital.

Abstract

BACKGROUND AND AIM:

In 2017, National Health Service Improvement set a 10% reduction target for Escherichia coli bacteraemia by 2018, followed by a 50% reduction in healthcare-associated Gram-negative bacteraemias by 2022. We analysed consecutive cases of E. coli bacteraemia and devised a strategy to achieve these targets.

METHODS:

From December 2012 to November 2013, demographic, clinical and microbiological data were prospectively collected on all patients with bacteraemia at the Royal London Hospital in East London, UK.

RESULTS:

There were 594 significant bacteraemic episodes and 207 (34.8%) were E. coli. Twenty-four (11.6%) of the E. coli isolates were extended spectrum beta-lactamase producers, 22 (10.6%) gentamicin resistant and 2 (1.0%) amikacin resistant. The three most common sites of infection were pyelonephritis 105 (56.7%), catheter-associated urinary tract infection 22 (10.6%), and other medical devices and procedures that cause bacteraemia 32 (15.5%). In the pyelonephritis group, trimethoprim resistance in urinary isolates was 16/47 (34.0%) compared with 3/47 (6.4%) for nitrofurantoin. Twelve months postbacteraemia, recurrent bacteraemia rates were 10/105 (9.5%). There were 44 medical device-associated E. coli bacteraemias, and 22 (50%) were urinary catheter associated. There were 10 patients with E. coli bacteraemia caused by procedures, seven genitourinary or biliary tract instrumentation and three postgastrointestinal surgery.

CONCLUSION:

E. coli bacteraemias related to urosepsis could have been prevented by better empirical treatment and targeted prophylaxis. Urinary catheter quality improvement programmes should contribute to a further reduction. For patients undergoing high-risk urinary or biliary tract procedures or device manipulation, we advocate single-dose amikacin prophylaxis.

• Authors: Desmond Hsu Dr, Mark Melzer
• Journal: Postgraduate medical journal (Postgrad Med J) Vol. 94 Issue 1110 Pg. 212-215 (Apr 2018) ISSN: 1469-0756 [Electronic] England
• PMID: 29463684 (Publication Type: Journal Article)
• Copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Chemical References

• Anti-Bacterial Agents

Topics

• Adolescent
• Adult
• Aged
• Anti-Bacterial Agents (therapeutic use)
• Antibiotic Prophylaxis
• Bacteremia (microbiology, prevention & control)
• Biliary Tract Diseases (surgery)
• Catheter-Related Infections (microbiology, prevention & control)
• Child
• Child, Preschool
• Cross Infection (microbiology, prevention & control)
• Drug Resistance, Multiple, Bacterial
• Escherichia coli Infections (microbiology, prevention & control)
• Female
• Health Services Research
• Hospitals, Teaching
• Humans
• London
• Male
• Middle Aged
• Prospective Studies
• Quality Improvement
• Urinary Catheterization (adverse effects, standards)
• Urinary Catheters (microbiology)
• Urinary Tract Infections (microbiology, prevention & control)
• Young Adult