Gram negative bacteraemia – are they preventable and what will E. coli surveillance add?

Abstract

The Department of Health in England introduced mandatory reporting of Escherichia coli bacteraemia in June 2011. We sought to determine the preventability of Gram negative bacteraemias and the efficacy of using E. coli bacteraemia as a surveillance tool. A six-month prospective study evaluated the preventability of Gram negative bacteraemias. Two investigators independently classified bacteraemias as preventable or not preventable. There were 141 bacteraemias (122 episodes) in 118 patients in the study period. E. coli was the most frequently isolated organism. Thirty five episodes (28.7%) were community onset, 24 (19.7%) hospital onset and 63 (51.6%) were healthcare-associated. Three bacteraemias (2.5%) were thought to be probably preventable and 21(17.2%) were thought to be possibly preventable. Factors associated with preventability by multivariable analysis included presence of a urinary catheter or central venous catheter and dependent functional state. A significant number of Gram negative bacteraemias were thought to be preventable, especially in patients with urinary catheters and central venous catheters. Surveillance of E. coli bacteraemias is an insensitive and non-specific method for identifying preventable Gram negative bacteraemias. We propose that targeted surveillance of patients with urinary catheters and central venous catheters in situ could help reduce infections.