1083. Underlying Foci and Risk Factors for Escherichia coli Bacteremia in England; Potential Targets for Intervention?
Session: Poster Abstract Session: Surveillance of HAIs: Implementation and National Perspectives
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background:

Escherichia coli is the leading pathogen causing bacteremia in England, accounting for one in three cases; in 2011 incidence was approximately 50.7 cases per 100,000 population (~30,000 cases).  We aimed to determine the underlying foci of infection and associated risk factors for E. coli bacteraemia in England.

Methods:

Enhanced E. coli bacteremia surveillance ran from November 2012-February 2013; 34 hospitals (out of 164) participating in English mandatory surveillance were randomly sampled to provide additional risk factor data for all cases. Descriptive analysis and logistic regression (to calculate adjusted odds ratios (aOR)) was performed.

Results:

The hospitals reported 1,519 cases representing 20% of all E. coli bacteremias reported in England during that period. Most (70%) reports were in those aged >=65 years. Fifty-three percent of cases were amongst women. An underlying genito-urinary tract (GUT) focus predominated comprising 50% of reports; hepatobiliary and unknown focus each comprised ~15%. Of the GUT associated bacteremias 85% were related to urinary tract infections. Factors associated with GUT E. coli bacteremia were:  urinary catheterisation (aOR 4.3; 2.8-6.6); those with blood cultures taken on admission (aOR 2.6; 1.5-4.4); surgical specialty (aOR 4.8; 1.9-12.0); female sex (aOR 1.7; 1.3-2.3); and receipt of antibiotics up to 4 weeks prior to bacteraemia (aOR 1.6; 1.1-2.2). Age was not associated upon adjustment. Subgroup analysis of patients with urinary catheters showed strong association between GUT focus and catheter type (Chi2 = 25.8; P<0.001); 82% of patients with long term catheters had GUT E. coli bacteremia compared to 50-60% of patients with other catheters.

Conclusion:

This population-based study has quantified the proportion of E. coli bacteremias in England associated with a GUT focus, confirming other smaller studies. Our analysis highlighted several groups at increased risk of E. coli bacteremia from a GUT focus.  Urinary tract infections comprised the largest group within GUT and are a clear target for monitoring and potential intervention.  The strong association of urinary catheters with GUT-related bacteremias suggests improved primary and acute care of such patients as a potential intervention to reduce E. coli bacteraemia incidence.

Julia Abernethy, BA (Hons), MSc, PhD1, Alan Johnson1, Susan Hopkins1, Dean Ironmonger2, Sobia Wasti1, Angela Falola1 and Russell Hope1, (1)Healthcare Associated Infection and Antimicrobial Resistance Department, Public Health England, London, United Kingdom, (2)Public Health England, Birmingham, United Kingdom

Disclosures:

J. Abernethy, None

A. Johnson, None

S. Hopkins, None

D. Ironmonger, None

S. Wasti, None

A. Falola, None

R. Hope, None

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