Interventions targeting the sources of Gram-negative bloodstream infections

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Evidence and guidelines for interventions that specifically target the most common sources of infection relating to Gram-negative bloodstream infections (GNBSI).

The most common sources of infection have been informed by the enhanced sentinel surveillance survey reviewed the epidemiology of Escherichia coli bacteraemia in England, Public Health England's mandatory surveillance reports, and the point prevalence survey of healthcare associated infections, antimicrobial use and antimicrobial stewardship in England 2016.

These resources are listed in a hierarchical order with systematic reviews first, guidelines and then examples of practice. 

Urinary tract infection (UTI)

The enhanced sentinel surveillance of Escherichia coli bloodstream infection (BSI) in England identified the urogenital tract as the most commonly reported source of infection (51.2%) and prior treatment for a urinary tract infection (UTI) being the most significant effect that was associated with UTI as a source.

The Public Health England mandatory surveillance of Gram-negative blood stream infection (GNBSI) annual report identified that for the source of E. coli BSI has changed little over time with 45-49% of cases having a UTI source. The urinary tract also forms a major source of Klebsiella species. BSI (36.2%) where time to onset prior to hospitalisation is two days and Pseudomonas aeruginosa (30%).

Catheter associated urinary tract infection

An enhanced survey of Escherichia coli bloodstream infection (BSI)

https://www.sciencedirect.com/science/article/pii/S0195670116305795

 was undertaken in England and identified the urogenital tract as the most commonly reported source of infection (51.2%). The report identified that 21% of all patients either had a urinary catheter in place at the time of their BSI or had previously had one inserted, removed or manipulated in the seven days prior to their BSI.

 The 2016 point prevalence survey of healthcare associated infections (HCAI), antimicrobial use and antimicrobial stewardship in England identified that of those HCAIs that were associated with a device, 45.0% of patients with a urinary tract infection (n=576) had a urinary catheter within seven days before onset.

Hepatobiliary

In the enhanced sentinel surveillance of E. coli bloodstream infection, the second most common focus of infection was the hepatobiliary tract (15.6%).

This section provides guidelines for the prevention of hepatobiliary infections. Prevention of these infections will help reduce those that progress to blood stream infection. 

Gastrointestinal tract

In the enhanced sentinel surveillance of E.coli bloodstream infection, the gastrointestinal tract was found to be the underlying focus of infection in 118 (7%) of infections.

The Public Health England surveillance of surgical site infections (SSIs) in NHS hospitals in England, (April 2016 to March 2017) identified that Enterobacteriaceae were the predominant cause of SSIs in large bowel surgery (53%). 

Febrile neutropenia and cancer

In the enhanced sentinel surveillance of E. coli bloodstream infection, febrile neutropenia tract was found to be the underlying focus of infection in 3% of infections.

Pneumonia and ventilator-associated pneumonia

In the enhanced sentinel surveillance of E. coli bloodstream infections, pneumonia was found to be the underlying focus of infection in 3% of infections.

The 2016 point prevalence survey of healthcare associated infections (HCAI), antimicrobial use and antimicrobial stewardship in England identified pneumonia or lower respiratory tract infections as the most common HCAI (29.2%). 

Ventilator-associated pneumonia

Topics of special interest

A list of guidelines, systematic reviews and resources/websites that are relevant to topics that are important in prevention and control of GNBSI. The first section is prevention of sepsis which is an essential component of any infection prevention and control programme.  

Sepsis

The prevention of sepsis is an essential component of any infection prevention and control programme.  

Antimicrobial stewardship tools and resources

Good antimicrobial stewardship programmes reduce the incidence of infections and colonisation with multi-drug resistant Gram-negative bacteria. 

Neonatal intensive care

A systematic review of Pseudomonas aeruginosa outbreaks in neonatal intensive care units looking at the risk factors in this vulnerable group of patients.

All resources were up-to-date at the time of publication. Please email nhsi.improveipc@nhs.net with any new resources for consideration.

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