University of Sussex
Browse
1/1
7 files

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

journal contribution
posted on 2023-06-09, 13:33 authored by Karina-Doris Vihta, Nicole Stoesser, Martin LlewelynMartin Llewelyn, T Phuong Quan, Tim Davies, Nicola J Fawcett, Laura Dunn, Katie Jeffrey, Chris C Butler, Gail Hayward, Monique Andersson, Marcus Morgan, Sarah Oakley, Amy Mason, Susan Hopkins, David H Wyllie, Derrick W Crook, Mark H Wilcox, Alan P Johnson, Tim E A Peto, Sarah Walker
Background Escherichia coli bloodstream infections are increasing in the UK and internationally. The evidence base to guide interventions against this major public health concern is small. We aimed to investigate possible drivers of changes in the incidence of E coli bloodstream infection and antibiotic susceptibilities in Oxfordshire, UK, over the past two decades, while stratifying for time since hospital exposure. Methods In this observational study, we used all available data on E coli bloodstream infections and E coli urinary tract infections (UTIs) from one UK region (Oxfordshire) using anonymised linked microbiological data and hospital electronic health records from the Infections in Oxfordshire Research Database (IORD). We estimated the incidence of infections across a two decade period and the annual incidence rate ratio (aIRR) in 2016. We modelled the data using negative binomial regression on the basis of microbiological, clinical, and health-care-exposure risk factors. We investigated infection severity, 30-day all-cause mortality, and community and hospital amoxicillin plus clavulanic acid (co-amoxiclav) use to estimate changes in bacterial virulence and the effect of antimicrobial resistance on incidence. Findings From Jan 1, 1998, to Dec 31, 2016, 5706 E coli bloodstream infections occurred in 5215 patients, and 228?376 E coli UTIs occurred in 137?075 patients. 1365 (24%) E coli bloodstream infections were nosocomial (onset >48 h after hospital admission), 1132 (20%) were quasi-nosocomial (=30 days after discharge), 1346 (24%) were quasi-community (31–365 days after discharge), and 1863 (33%) were community (>365 days after hospital discharge). The overall incidence increased year on year (aIRR 1·06, 95% CI 1·05–1·06). In 2016, 212 (41%) of 515 E coli bloodstream infections and 3921 (28%) of 13?792 E coli UTIs were co-amoxiclav resistant. Increases in E coli bloodstream infections were driven by increases in community (aIRR 1·10, 95% CI 1·07–1·13; p<0·0001) and quasi-community (aIRR 1·08, 1·07–1·10; p<0·0001) cases. 30-day mortality associated with E coli bloodstream infection decreased over time in the nosocomial (adjusted rate ratio [RR] 0·98, 95% CI 0·96–1·00; p=0·03) group, and remained stable in the quasi-nosocomial (adjusted RR 0·98, 0·95–1·00; p=0·06), quasi-community (adjusted RR 0·99, 0·96–1·01; p=0·32), and community (adjusted RR 0·99, 0·96–1·01; p=0·21) groups. Mortality was, however, substantial at 14–25% across all hospital-exposure groups. Co-amoxiclav-resistant E coli bloodstream infections increased in all groups across the study period (by 11–18% per year, significantly faster than co-amoxiclav-susceptible E coli bloodstream infections; pheterogeneity<0·0001), as did co-amoxiclav-resistant E coli UTIs (by 14–29% per year; pheterogeneity<0·0001). Previous year co-amoxiclav use in primary-care facilities was associated with increased subsequent year community co-amoxiclav-resistant E coli UTIs (p=0·003). Interpretation Increases in E coli bloodstream infections in Oxfordshire are primarily community associated, with substantial co-amoxiclav resistance; nevertheless, we found little or no change in mortality. Focusing interventions on primary care facilities, particularly those with high co-amoxiclav use, could be effective in reducing the incidence of co-amoxiclav-resistant E coli bloodstream infections, in this region and more generally.

History

Publication status

  • Published

File Version

  • Accepted version

Journal

Lancet Infectious Diseases

ISSN

1473-3099

Publisher

Elsevier

Issue

10

Volume

18

Page range

1138-1149

Department affiliated with

  • Global Health and Infection Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2018-05-30

First Open Access (FOA) Date

2019-02-17

First Compliant Deposit (FCD) Date

2018-05-30

Usage metrics

    University of Sussex (Publications)

    Categories

    No categories selected

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC