title: Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme.
abstract: BACKGROUND
  Escherichia coli causes more than one-third of the bacteraemia cases in England each year, and the incidence of these infections is increasing.
  
  
  OBJECTIVE
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: National Infection Service, Public Health England, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Abernethy
authors.affiliation: National Infection Service, Public Health England, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Guy
authors.affiliation: National Infection Service, Public Health England, London, UK; Poole Hospital NHS Trust, Poole, UK.
authors.forename: E A
authors.initials: EA
authors.lastname: Sheridan
authors.affiliation: Royal Free London NHS Foundation Trust, London, UK; Public Health Strategy, Public Health England, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hopkins
authors.affiliation: University of West London, Richard Wells Research Centre, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Kiernan
authors.affiliation: Leeds Teaching Hospitals and University of Leeds, Leeds, UK.
authors.forename: M H
authors.initials: MH
authors.lastname: Wilcox
authors.affiliation: National Infection Service, Public Health England, London, UK.
authors.forename: A P
authors.initials: AP
authors.lastname: Johnson
authors.affiliation: National Infection Service, Public Health England, London, UK. Electronic address: Russell.hope@phe.gov.uk.
authors.forename: R
authors.initials: R
authors.lastname: Hope
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology*; D001769:Blood / Q000382:microbiology; D004739:England / Q000453:epidemiology; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology*; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests; D012307:Risk Factors; D018571:Sentinel Surveillance; D014556:Urine / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Community; Healthcare-associated; Risk factors; Urinary tract infection