Preventing healthcare-associated Gram-negative bloodstream infections

Gray, J.; Oppenheim, Beryl; Mahida, Nikunj

doi:10.1016/j.jhin.2018.01.008

Cited by 6 publications

(7 citation statements)

References 17 publications

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“…Although of large clinical and economic significance, this represents only a fraction of the projected incidence of healthcare-associated E. coli bacteraemia (exceeding 30,000 by 2021) [31]. Potential limited capacity of hospital catheter interventions to reduce GNBSI burden is consistent with the viewpoint that multi-faceted, community-oriented approaches are necessary to tackle the many, as yet poorly understood sources of GNBSI [9,13,32].…”

Section: Discussionmentioning

confidence: 88%

“…Urinary catheters (henceforth 'catheters') are associated with the majority of urinary HCAIs and are an important risk factor for the incidence and severity of GNBSI [4e7]. Yet catheters are often inserted without appropriate indication and left in for longer than clinically necessary [8], putting patients needlessly at risk of infection and contributing to the burden imposed by HCAI and GNBSI in England's National Health Service (NHS) [1,9].…”

Section: Introductionmentioning

confidence: 99%

“…In response to an unprecedented increase in the incidence of GNBSI, in 2016 the UK Government pledged to halve healthcare-associated GNBSI by 2020 [10]. Achieving reductions of this scale is made difficult by resource constraints and the fact that most GNBSIs are caused by typically commensal bacteria such as Escherichia coli [9,11]. However, recent estimates suggest that 34e56% of hospital catheter-associated UTIs (CAUTIs) may be preventable, in particular through prevention of unnecessary urinary catheterization [12].…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology and health-economic burden of urinary-catheter-associated infection in English NHS hospitals: a probabilistic modelling study

Pouwels

Hopkins

et al. 2019

Journal of Hospital Infection

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accounted for 47% (UI 32e67%) and 97% (UI 93e98%) of direct costs and QALYs lost. Every catheter prevented could save £30 (UI £20e44) in direct hospital costs and £112 (UI £52 e146) in QALY value. Conclusions: Hospital catheter prevention is poised to reap substantial health-economic gains, but community-oriented interventions are needed to target the large burden imposed by community-onset infection.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Epidemiology and health-economic burden of urinary-catheter-associated infection in English NHS hospitals: a probabilistic modelling study

Pouwels

Hopkins

et al. 2019

Journal of Hospital Infection

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“…[4][5][6][7] In England, more than 70% of antibiotics are prescribed in primary care, many of which are deemed inappropriate. 8 To control antibiotic resistance, antimicrobial stewardship interventions targeting antibiotic prescribing in primary care settings have been introduced. 9 The Quality Premium is a National Health Service (NHS) England intervention that provided performancerelated financial rewards to clinically led statutory bodies, known as Clinical Commissioning Groups, who are responsible for planning and commissioning local health-care services.…”

Section: Introductionmentioning

confidence: 99%

“… 4 , 5 , 6 , 7 In England, more than 70% of antibiotics are prescribed in primary care, many of which are deemed inappropriate. 8 To control antibiotic resistance, antimicrobial stewardship interventions targeting antibiotic prescribing in primary care settings have been introduced. 9…”

Section: Introductionmentioning

confidence: 99%

Effect of antibiotic stewardship interventions in primary care on antimicrobial resistance of Escherichia coli bacteraemia in England (2013–18): a quasi-experimental, ecological, data linkage study

Aliabadi

Anyanwu

Beech³

et al. 2021

The Lancet Infectious Diseases

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Background Antimicrobial resistance is a major global health concern, driven by overuse of antibiotics. We aimed to assess the effectiveness of a national antimicrobial stewardship intervention, the National Health Service (NHS) England Quality Premium implemented in 2015-16, on broad-spectrum antibiotic prescribing and Escherichia coli bacteraemia resistance to broad-spectrum antibiotics in England.Methods In this quasi-experimental, ecological, data linkage study, we used longitudinal data on bacteraemia for patients registered with a general practitioner in the English National Health Service and patients with E coli bacteraemia notified to the national mandatory surveillance programme between Jan 1, 2013, and Dec 31, 2018. We linked these data to data on antimicrobial susceptibility testing of E coli from Public Health England's Second-Generation Surveillance System. We did an ecological analysis using interrupted time-series analyses and generalised estimating equations to estimate the change in broad-spectrum antibiotics prescribing over time and the change in the proportion of E coli bacteraemia cases for which the causative bacteria were resistant to each antibiotic individually or to at least one of five broad-spectrum antibiotics (co-amoxiclav, ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin), after implementation of the NHS England Quality Premium intervention in April, 2015.Findings Before implementation of the Quality Premium, the rate of antibiotic prescribing for all five broad-spectrum antibiotics was increasing at rate of 0•2% per month (incidence rate ratio [IRR] 1•002 [95% CI 1•000-1•004], p=0•046). After implementation of the Quality Premium, an immediate reduction in total broad-spectrum antibiotic prescribing rate was observed (IRR 0•867 [95% CI 0•837-0•898], p<0•0001). This effect was sustained until the end of the study period; a 57% reduction in rate of antibiotic prescribing was observed compared with the counterfactual situation (ie, had the Quality Premium not been implemented). In the same period, the rate of resistance to at least one broad-spectrum antibiotic increased at rate of 0•1% per month (IRR 1•001 [95% CI 0•999-1•003], p=0•346). On implementation of the Quality Premium, an immediate reduction in resistance rate to at least one broad-spectrum antibiotic was observed (IRR 0•947 [95% CI 0•918-0•977], p=0•0007). Although this effect was also sustained until the end of the study period, with a 12•03% reduction in resistance rate compared with the counterfactual situation, the overall trend remained on an upward trajectory. On examination of the long-term effect following implementation of the Quality Premium, there was an increase in the number of isolates resistant to at least one of the five broadspectrum antibiotics tested (IRR 1•002 [1•000-1•003]; p=0•047).Interpretation Although interventions targeting antibiotic use can result in changes in resistance over a short period, they might be insufficient alone to curtail antimicrobial resistance.

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Preventing healthcare-associated infection by sharing research, evidence and best practice

Gray

Winzor

Mahdia

et al. 2019

Journal of Hospital Infection

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Preventing healthcare-associated Gram-negative bloodstream infections

Cited by 6 publications

References 17 publications

Epidemiology and health-economic burden of urinary-catheter-associated infection in English NHS hospitals: a probabilistic modelling study

Epidemiology and health-economic burden of urinary-catheter-associated infection in English NHS hospitals: a probabilistic modelling study

Effect of antibiotic stewardship interventions in primary care on antimicrobial resistance of Escherichia coli bacteraemia in England (2013–18): a quasi-experimental, ecological, data linkage study

Preventing healthcare-associated infection by sharing research, evidence and best practice

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