Towards the National Gram Negative Bloodstream Infection Reduction Objectives: Identification of Risk Factors in the Acute Setting to Inform Reduction Strategies

Background/Aims: In November 2016, the Department of Health announced ambitions to halve the number of Gram-Negative Bloodstream Infections (BSI) by 2020/21; specifically, a reduction of 50% in Escherichia coli BSI. The main aim of this project was to identify risk factors following a review of E. coli BSI occurring at a large acute teaching hospital in the North West of England. It was hoped that this would identify potential interventions to facilitate achieving the reduction objectives. Methods: All cases of E. coli bacteraemia submitted as part of mandatory returns between 2012 and 2017 were aggregated. Demographic and episode-level data were appended to the data set with laboratory data on antibiotic susceptibility. Common themes were determined for cases recorded during 2015 and 2016 through descriptive epidemiological methods. Results: There were a total of 578 E. coli BSI reported during this period: 348 (60.2%) were collected prior to the third day of admission (community-associated) and 230 (39.8%) were collected on or after the third day of admission (hospital-associated). In both community and hospital-associated cases, 90% and 82% of cases respectively can be attributed to a primary focus of either urinary, hepatobiliary or gastrointestinal tract. Resistance rates to commonly prescribed antibiotics were described in detail. Conclusion: Regular analysis of E. coli BSI in both the primary care and acute settings is essential in informing public health management strategies. It is hoped that identified risk factors and suggested interventions can further reduce reported cases in order to meet this target.