Descriptive epidemiology of Escherichia coli bacteraemia in England, April 2012 to March 2014

Euro Surveill. 2016 Sep 1;21(35):30329. doi: 10.2807/1560-7917.ES.2016.21.35.30329.

Abstract

We determined the incidence, risk factors and antimicrobial susceptibility associated with Escherichia coli bacteraemia in England over a 24 month period. Case data were obtained from the national mandatory surveillance database, with susceptibility data linked from LabBase2, a voluntary national microbiology database. Between April 2012 and March 2014, 66,512 E. coli bacteraemia cases were reported. Disease incidence increased by 6% from 60.4 per 100,000 population in 2012-13 to 63.5 per 100,000 population in 2013-14 (p < 0.0001). Rates of E. coli bacteraemia varied with patient age and sex, with 70.5% (46,883/66,512) of cases seen in patients aged ≥ 65 years and 52.4% (33,969/64,846) of cases in females. The most common underlying cause of bacteraemia was infection of the genital/urinary tract (41.1%; 27,328/66,512), of which 98.4% (26,891/27,328) were urinary tract infections (UTIs). The majority of cases (76.1%; 50,617/66,512) had positive blood cultures before or within two days of admission and were classified as community onset cases, however 15.7% (10,468/66,512) occurred in patients who had been hospitalised for over a week. Non-susceptibility to ciprofloxacin, third-generation cephalosporins, piperacillin-tazobactam, gentamicin and carbapenems were 18.4% (8,439/45,829), 10.4% (4,256/40,734), 10.2% (4,694/46,186), 9.7% (4,770/49,114) and 0.2% (91/42,986), respectively. Antibiotic non-susceptibility was higher in hospital-onset cases than for those presenting from the community (e.g. ciprofloxacin non-susceptibility was 22.1% (2,234/10,105) for hospital-onset vs 17.4% (5,920/34,069) for community-onset cases). Interventions to reduce the incidence of E. coli bacteraemia will have to target the community setting and UTIs if substantial reductions are to be realised.

Keywords: Antimicrobial resistance; Bacteraemia; Bloodstream infection; Epidemiology; Escherichia coli; Population.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / epidemiology*
  • Child
  • Child, Preschool
  • Community-Acquired Infections / epidemiology
  • Cross Infection / epidemiology
  • Drug Resistance, Bacterial
  • England / epidemiology
  • Escherichia coli / drug effects
  • Escherichia coli / isolation & purification*
  • Escherichia coli Infections / blood
  • Escherichia coli Infections / diagnosis*
  • Escherichia coli Infections / drug therapy
  • Escherichia coli Infections / epidemiology*
  • Female
  • Humans
  • Incidence
  • Infant
  • Male
  • Mandatory Reporting
  • Middle Aged
  • Population Surveillance
  • Risk Factors
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / etiology*
  • Young Adult

Substances

  • Anti-Bacterial Agents