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We determined the incidence, risk factors and antimicrobial susceptibility associated with bacteraemia in England over a 24 month period. 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 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 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 bacteraemia will have to target the community setting and UTIs if substantial reductions are to be realised.


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  1. Public Health England (PHE). Health Protection Report: Voluntary surveillance of Escherichia coli bacteraemia in England, Wales and Northern Ireland: 2009-2013. London: PHE; 16 May 2014. [Accessed January 2015]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/339992/Ecoli_bacteraemia_in_Eng_Wales_and_NI_2009_to_2013.pdf
  2. Gagliotti C, Balode A, Baquero F, Degener J, Grundmann H, Gür D, et al. . Escherichia coli and Staphylococcus aureus: bad news and good news from the European Antimicrobial Resistance Surveillance Network (EARS-Net, formerly EARSS), 2002 to 2009. Euro Surveill. 2011;16(11):19819. PMID: 21435327 
  3. Berger J, Diab-Elschahawi M, Blacky A, Pernicka E, Spertini V, Assadian O, et al. A matched prospective cohort study on Staphylococcus aureus and Escherichia coli bloodstream infections: extended perspectives beyond resistance. Am J Infect Control. 2010;38(10):839-45.  https://doi.org/10.1016/j.ajic.2010.04.212  PMID: 20650546 
  4. Bo S-N, Bo J, Ning Y-Z, Zhao Y, Lu X-L, Yang J-Y, et al. Relationship between time to positivity of blood culture with clinical characteristics and hospital mortality in patients with Escherichia coli bacteremia. Chin Med J (Engl). 2011;124(3):330-4. PMID: 21362328 
  5. Uslan DZ, Crane SJ, Steckelberg JM, Cockerill FR 3rd, St Sauver JL, Wilson WR, et al. Age- and sex-associated trends in bloodstream infection: a population-based study in Olmsted County, Minnesota. Arch Intern Med. 2007;167(8):834-9.  https://doi.org/10.1001/archinte.167.8.834  PMID: 17452548 
  6. Abernethy JK, Johnson AP, Guy R, Hinton N, Sheridan EA, Hope RJ. Thirty day all-cause mortality in patients with Escherichia coli bacteraemia in England. Clin Microbiol Infect. 2015;21(3):251.e1-8.  https://doi.org/10.1016/j.cmi.2015.01.001  PMID: 25698659 
  7. Melzer M, Petersen I. Mortality following bacteraemic infection caused by extended spectrum beta-lactamase (ESBL) producing E. coli compared to non-ESBL producing E. coli. J Infect. 2007;55(3):254-9.  https://doi.org/10.1016/j.jinf.2007.04.007  PMID: 17574678 
  8. Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis. 2006;42(Suppl 2):S82-9.  https://doi.org/10.1086/499406  PMID: 16355321 
  9. Office for National Statistics (ONS). Population Estimates for UK, England and Wales, Scotland and Northern Ireland, Mid-2011 and Mid-2012 2013. Updated 08/08/20132014. London: ONS. Available from: http://webarchive.nationalarchives.gov.uk/20160105160709/http://www.ons.gov.uk/ons/rel/pop-estimate/population-estimates-for-uk--england-and-wales--scotland-and-northern-ireland/mid-2011-and-mid-2012/index.html
  10. England National Health Service (NHS England). KH03: Bed Availability and Occupancy Data – Overnight. NHS Organisations in England for 2012-14. Leeds: NHS England; 2014. Available from: https://www.england.nhs.uk/statistics/statistical-work-areas/bed-availability-and-occupancy/bed-data-overnight/
  11. Health and Social Care Information Centre (HSCIC). ERIC - Estates Return Information Collection: 2012-13 Data return. Leeds: HSCIC; 2014, [Accessed August 2014]. Available from: http://hefs.hscic.gov.uk/DataFiles.asp
  12. Siegman-Igra Y, Fourer B, Orni-Wasserlauf R, Golan Y, Noy A, Schwartz D, et al. Reappraisal of community-acquired bacteremia: a proposal of a new classification for the spectrum of acquisition of bacteremia. Clin Infect Dis. 2002;34(11):1431-9.  https://doi.org/10.1086/339809  PMID: 12015688 
  13. Livermore DM, Hope R, Reynolds R, Blackburn R, Johnson AP, Woodford N. Declining cephalosporin and fluoroquinolone non-susceptibility among bloodstream Enterobacteriaceae from the UK: links to prescribing change? J Antimicrob Chemother. 2013;68(11):2667-74.  https://doi.org/10.1093/jac/dkt212  PMID: 23766490 
  14. Al-Hasan MN, Lahr BD, Eckel-Passow JE, Baddour LM. Seasonal variation in Escherichia coli bloodstream infection: a population-based study. Clin Microbiol Infect. 2009;15(10):947-50.  https://doi.org/10.1111/j.1469-0691.2009.02877.x  PMID: 19845704 
  15. Deeny SR, van Kleef E, Bou-Antoun S, Hope RJ, Robotham JV. Seasonal changes in the incidence of Escherichia coli bloodstream infection: variation with region and place of onset. Clin Microbiol Infect. 2015;21(10):924-9.  https://doi.org/10.1016/j.cmi.2015.06.023  PMID: 26141255 
  16. Whitehead M, Doran T. The north-south health divide. BMJ. 2011;342(feb15 2):d584.  https://doi.org/10.1136/bmj.d584  PMID: 21325006 
  17. Kennedy KJ, Roberts JL, Collignon PJ. Escherichia coli bacteraemia in Canberra: incidence and clinical features. Med J Aust. 2008;188(4):209-13. PMID: 18279126 
  18. Laupland KB, Gregson DB, Church DL, Ross T, Pitout JDD. Incidence, risk factors and outcomes of Escherichia coli bloodstream infections in a large Canadian region. Clin Microbiol Infect. 2008;14(11):1041-7.  https://doi.org/10.1111/j.1469-0691.2008.02089.x  PMID: 19040476 
  19. Laupland KB, Gregson DB, Flemons WW, Hawkins D, Ross T, Church DL. Burden of community-onset bloodstream infection: a population-based assessment. Epidemiol Infect. 2007;135(6):1037-42.  https://doi.org/10.1017/S0950268806007631  PMID: 17156500 
  20. Williamson DA, Lim A, Wiles S, Roberts SA, Freeman JT. Population-based incidence and comparative demographics of community-associated and healthcare-associated Escherichia coli bloodstream infection in Auckland, New Zealand, 2005-2011. BMC Infect Dis. 2013;13(1):385.  https://doi.org/10.1186/1471-2334-13-385  PMID: 23964864 
  21. Holt PG, Jones CA. The development of the immune system during pregnancy and early life. Allergy. 2000;55(8):688-97.  https://doi.org/10.1034/j.1398-9995.2000.00118.x  PMID: 10955693 
  22. Weng N-P. Aging of the immune system: how much can the adaptive immune system adapt? Immunity. 2006;24(5):495-9.  https://doi.org/10.1016/j.immuni.2006.05.001  PMID: 16713964 
  23. Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al. . Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011;127(5):817-26.  https://doi.org/10.1542/peds.2010-2217  PMID: 21518717 
  24. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon. 2003;49(2):53-70.  https://doi.org/10.1067/mda.2003.7  PMID: 12601337 
  25. Nielsen SL, Pedersen C, Jensen TG, Gradel KO, Kolmos HJ, Lassen AT. Decreasing incidence rates of bacteremia: a 9-year population-based study. J Infect. 2014;69(1):51-9.  https://doi.org/10.1016/j.jinf.2014.01.014  PMID: 24576825 
  26. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, et al. Health care--associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002;137(10):791-7.  https://doi.org/10.7326/0003-4819-137-10-200211190-00007  PMID: 12435215 
  27. Rafferty AM, Clarke SP, Coles J, Ball J, James P, McKee M, et al. Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records. Int J Nurs Stud. 2007;44(2):175-82.  https://doi.org/10.1016/j.ijnurstu.2006.08.003  PMID: 17064706 
  28. Kanerva M, Ollgren J, Lyytikäinen OFinnish Prevalence Survey Study Group. Interhospital differences and case-mix in a nationwide prevalence survey. J Hosp Infect. 2010;76(2):135-8.  https://doi.org/10.1016/j.jhin.2010.05.017  PMID: 20663587 
  29. Factors Contributing to the Emergence of Resistance. In: Knobler SL, Lemon SM, Najafi M, et al., editors. The Resistance Phenomenon in Microbes and Infectious Disease Vectors: Implications for Human Health and Strategies for Containment: Workshop Summary. Washington (DC): National Academies Press (US); 2003.
  30. Bos MMEM, Smeets LS, Dumay I, de Jonge E. Bloodstream infections in patients with or without cancer in a large community hospital. Infection. 2013;41(5):949-58.  https://doi.org/10.1007/s15010-013-0468-1  PMID: 23645474 
  31. Ha YE, Kang C-I, Cha MK, Park SY, Wi YM, Chung DR, et al. Epidemiology and clinical outcomes of bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli in patients with cancer. Int J Antimicrob Agents. 2013;42(5):403-9.  https://doi.org/10.1016/j.ijantimicag.2013.07.018  PMID: 24071027 
  32. Courpon-Claudinon A, Lefort A, Panhard X, Clermont O, Dornic Q, Fantin B, et al. COLIBAFI Group. Bacteraemia caused by third-generation cephalosporin-resistant Escherichia coli in France: prevalence, molecular epidemiology and clinical features. Clin Microbiol Infect. 2011;17(4):557-65.  https://doi.org/10.1111/j.1469-0691.2010.03298.x  PMID: 20649802 
  33. Public Health England (PHE). English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) 2014. London: PHE. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/362374/ESPAUR_Report_2014__3_.pdf
  34. Steinke DT, Seaton RA, Phillips G, MacDonald TM, Davey PG. Prior trimethoprim use and trimethoprim-resistant urinary tract infection: a nested case-control study with multivariate analysis for other risk factors. J Antimicrob Chemother. 2001;47(6):781-7.  https://doi.org/10.1093/jac/47.6.781  PMID: 11389110 
  35. Rodríguez-Baño J, Navarro MD, Romero L, Muniain MA, de Cueto M, Gálvez J, et al. Risk-factors for emerging bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. Clin Microbiol Infect. 2008;14(2):180-3.  https://doi.org/10.1111/j.1469-0691.2007.01884.x  PMID: 18005358 

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