Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme

Abernethy, Julia; Guy, Rebecca; Sheridan, Elizabeth; Wilcox, Mark H.; Johnson, Alan P.; Hope, Russell; Sen, Rachel A.; Mifsud, Adrian; O'Driscoll, J.; Brown, Nicholas M.; Trundle, C.; Allison, Dale C.; Twagira, Mary; Gnanarajah,; Kariem, F. Awad-El; Rajendran, R.; Umashankar, Saumya; Horne, Geoffrey; Claxton, Ami J.; Cheesbrough, J.; Kirby, Andrew; Mulla, Rohinton; Teare, L.; Rosmarin, Caryn; Rao, G. Gopal; Richards, DeAnn; Boswell, Tim; Bowler, I.C.J.W.; O’Connor, Lily; Jenks, Peter J.; Wyllie, Samuel; Virgincar, N.; Hopkins, Susan; Dall’Antonia, Martino; Rodgers, Anthony; Ellis, Robert; Bowley, J.A.; Kiernan, Martin; Knox, Katherine; Riley, Unell; Kelsey, M.C.; Wilson, Philip; Shetty, Nandini; Orendi, J M; Pasztor, Monika

doi:10.1016/j.jhin.2016.12.008

Cited by 93 publications

(66 citation statements)

References 16 publications

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“…We found that the increase in incidence of nosocomial E coli bloodstream infection was significantly smaller than for community and quasi-community E coli bloodstream infections in Oxfordshire, as was observed nationally. 10 Multiple infection control interventions were rolled out in UK hospitals from 2005 to 2010 35,36 in response to MRSA and C difficile, and horizontal components could have helped to lower the incidence of nosocomial infections. Furthermore, in the USA, increases in hospital-onset Gram-negative bloodstream infections decreased after introduction of an MRSA prevention initiative, while community-acquired incidence remained unchanged.…”

Section: Discussionmentioning

confidence: 99%

“…7 For instance, recurrences in E coli bloodstream infection explain little of the ongoing increasing incidence, and the incidence of both co-amoxiclav-resistant and coamoxiclav-susceptible E coli bloodstream infections are increasing. An England-wide study 10 found that 51% of E coli bloodstream infections had an underlying urogenital-tract focus, with UTI treatment in the previous 4 weeks being the largest independent risk factor. 10 Similarly, we found that 42% of E coli bloodstream infections were potentially amenable to urinary-focused intervention, with 13% of E coli bloodstream infections classified as likely to be urine associated, and 28% presenting as urosepsis.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the source of E coli bloodstream infection might also differ by recency of hospital exposure. One study 10 found that about 50% of E coli bloodstream infections in England were most likely to be due to urinary tract infections (UTIs). Another study 7 by Public Health England supports these findings, but also found that gastrointestinal foci are a more common source of infection among inpatients than among individuals in the community.…”

Section: Introductionmentioning

confidence: 99%

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Trends over time in Escherichia coli bloodstream infections, urinary tract infections, and antibiotic susceptibilities in Oxfordshire, UK, 1998–2016: a study of electronic health records

Vihta

Stoesser

Llewelyn

et al. 2018

The Lancet Infectious Diseases

127

103

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Trends over time in Escherichia coli bloodstream infections, urinary tract infections, and antibiotic susceptibilities in Oxfordshire, UK, 1998–2016: a study of electronic health records

Vihta

Stoesser

Llewelyn

et al. 2018

The Lancet Infectious Diseases

127

103

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“…Overall, 42% of EC-BSI appeared to be more likely amenable to urinary-focussed intervention, similar to a Englandwide study that found 51% of EC-BSIs had an underlying urogenital tract focus, with the largest independent risk factor for these being treatment for UTI in the prior four weeks. 8 In our study, 13% of EC-BSIs were likely urine-associated and 28% presented as urosepsis;…”

Section: Discussionmentioning

confidence: 50%

“…The increasing trend in nosocomial EC-BSI was significantly smaller than for community/quasi-community EC-BSI in Oxfordshire, as observed nationally. 8 Multiple infection control interventions were rolled out in UK hospitals from 2005-2010 24,25 in response to MRSA/C. difficile, and horizontal components of these initiatives could have contributed to these lower nosocomial rates.…”

Section: Discussionmentioning

confidence: 99%

Trends in Escherichia coli bloodstream infection, urinary tract infections and antibiotic susceptibilities in Oxfordshire, 1998-2016: an observational study

Vihta

Stoesser

Llewelyn

et al. 2017

Preprint

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Background: The incidence of Escherichia coli bloodstream infections (EC-BSIs), particularly those caused by antibiotic-resistant strains, is increasing in the UK and internationally. This is a major public health concern but the evidence base to guide interventions is limited. Methods:Incidence of EC-BSIs and E. coli urinary tract infections (EC-UTIs) in one UK region (Oxfordshire) were estimated from anonymised linked microbiological and hospital electronic health records, and modelled using negative binomial regression based on microbiological, clinical and healthcare exposure risk factors. Infection severity, 30-day allcause mortality, and community and hospital co-amoxiclav use were also investigated.Findings: From 1998From -2016 EC-BSIs occurred in 5215 patients, and 228376 EC-UTIs in 137075 patients. 1365(24%) EC-BSIs were nosocomial (onset >48h post-admission), 1863(33%) were community (>365 days post-discharge), 1346(24%) were quasi-community (31-365 days post-discharge), and 1132(20%) were quasi-nosocomial (≤30 days postdischarge). 1413(20%) EC-BSIs and 36270(13%) EC-UTIs were co-amoxiclav-resistant (41% and 30%, respectively, in 2016). Increases in EC-BSIs were driven by increases in community (10%/year (95% CI:7%-13%)) and quasi-community (8%/year (95% CI:7%-10%)) cases. Changes in EC-BSI-associated 30-day mortality were at most modest (p>0·03), and mortality was substantial (14-25% across groups). By contrast, co-amoxiclav-resistant ECBSIs increased in all groups (by 11%-19%/year, significantly faster than susceptible ECBSIs, p heterogeneity <0·001), as did co-amoxiclav-resistant EC-UTIs (by 13%-29%/year, p heterogeneity <0·001). Co-amoxiclav use in primary-care facilities was associated with subsequent co-amoxiclav-resistant EC-UTIs (p=0·03) and all EC-UTIs (p=0·002).Interpretation: Current increases in EC-BSIs in Oxfordshire are primarily communityassociated, with high rates of co-amoxiclav resistance, nevertheless not impacting mortality.Interventions should target primary-care facilities with high co-amoxiclav usage.

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Feasibility of tracking invasive Escherichia coli disease among older adults in a community setting: A prospective observational study

Doua,

Ekkelenkamp,

Verheij

et al. 2024

Eur J Clin Microbiol Infect Dis

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Purpose Invasive Escherichia coli disease (IED) encompasses a diverse range of sterile site infections. This study evaluated the feasibility of capturing IED among community-dwelling older adults to inform the implementation of a phase 3 efficacy trial of a novel vaccine against IED (NCT04899336). Methods EXPECT-1 (NCT04087681) was a prospective, multinational, observational study conducted in medically stable participants aged ≥ 60 years. At least 50% of participants were selected based on a history of urinary tract infection (UTI) in the previous 10 years. The main outcomes were the incidence of IED and the number of hospitalisations reported by the site vs participant. The length of follow-up was 12 months. In a US-based substudy, a smartphone-based geofencing was evaluated to track hospital entries. Results In total, 4470 participants were enrolled (median age, 70.0 years); 59.5% (2657/4469) of participants had a history of UTI in the previous 10 years. Four IED events were captured through deployment of different tracking methods: a self-report, a general practitioner (GP) report, and a follow-up call. The incidence rate of IED was 98.6 events per 100,000 person-years. The number of reported hospitalisations was 2529/4470 (56.6%) by the site and 2177/4470 (48.7%) by participants; 13.8% of hospitalisations would have been missed if utilising only site reports. Geofencing detected 72 hospital entries. Conclusion Deployment of multiple tracking methods can optimise detection of IED among community-dwelling older adults. Older adults with a history of UTI could be feasibly targeted for a phase 3 vaccine efficacy trial through a network of GPs.

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Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme

Abstract: Background: Escherichia coli causes over one third of the bacteraemia cases in England each year, and the incidence of these infections is increasing.

Cited by 93 publications

References 16 publications

Trends over time in Escherichia coli bloodstream infections, urinary tract infections, and antibiotic susceptibilities in Oxfordshire, UK, 1998–2016: a study of electronic health records

Trends over time in Escherichia coli bloodstream infections, urinary tract infections, and antibiotic susceptibilities in Oxfordshire, UK, 1998–2016: a study of electronic health records

Trends in Escherichia coli bloodstream infection, urinary tract infections and antibiotic susceptibilities in Oxfordshire, 1998-2016: an observational study

Feasibility of tracking invasive Escherichia coli disease among older adults in a community setting: A prospective observational study

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