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COMMENT E. coli: a brief overview Symptoms of urosepsis

 

E. coli is one of the most common causes of

 

bacteraemia and is usually associated with UTIs,

 

Table 1. Financial year annual counts of

 

E. coli bacteraemia in London acute trusts

 

2013?14 especially in cases of urinary tract obstruction.

 

In addition to symptoms of UTI, non?lifethreatening E. coli bacteraemia may manifest with

 

sudden onset of fever, tachycardia, tachypnoea and

 

delirium. However E. coli bacteraemia can lead to

 

septic shock, manifesting with hypotension and

 

fever or hypotension and hypothermia. In severe

 

cases it may be complicated by uremia, hepatic

 

failure, acute respiratory distress syndrome,

 

coma and death. It is the systemic reaction to

 

endotoxin (cytokines) or lipopolysaccharides

 

that occurs with the bacteraemia that can lead to

 

disseminated intravascular coagulation and death

 

(Madappa, 2014).

 

The recurrence rate after a first E coli infection

 

is 44% over 12 months (Madappa, 2014).

 

Reservoirs of bacteria existing within the

 

urothelial cells may contribute to this. It has

 

been shown that uropathogenic E. coli are able

 

to invade and colonise the epithelial cells of the

 

bladder in both animals (Anderson et al, 2003)

 

and in women with recurrent cystitis (Rosen

 

et al, 2003). Here they can remain protected

 

from both antibiotics and the body?s immune

 

defences, only to recolonise the bladder and

 

cause further acute infection as these cells are

 

shed (Khasriya et al, 2013). Barking, Havering and Redbridge

 

Hospitals 436 Barnet and Chase Farm Hospitals 302 Barts Health 664 Chelsea and Westminster Hospital 73 Croydon Health Services 153 Ealing Hospital 125 Incidence of E.coli bacteraemia Epsom and St Helier University

 

Hospitals 217 Great Ormond Street Hospital for

 

Children 23 Guy?s and St Thomas? 229 Homerton University Hospital 124 Imperial College Healthcare 342 King?s College Hospital 437 Kingston Hospital 129 Lewisham and Greenwich 276 Moorfields Eye Hospital 0 North Middlesex University Hospital 134 North West London Hospitals 244 Royal Brompton and Harefield 8 Royal Free Hampstead 231 Royal National Orthopaedic Hospital 3 St George?s Healthcare 233 The Hillingdon Hospitals 149 The Royal Marsden 85 The Whittington Hospital 114 University College London Hospitals 259 West Middlesex University Hospital 165 The reported incidence of E. coli bacteraemia

 

across acute trusts in England for 2012?13

 

was 93.8 per 100?000 bed days and in 2013?

 

14 was 99.9 per 100?000 bed days (Public

 

Health England (PHE), 2014a).There have

 

been year-on-year increases in the number of

 

E. coli bacteraemia reports, with similar trends

 

in other nations within the UK, and by 2013

 

E.coli accounted for 31.5% of all bacteraemia

 

reports, compared with 27.2% in 2009 (PHE,

 

2014a). The rates per 100?000 population of

 

E. coli bacteraemia were highest in patients

 

aged 65 years and over and in those under

 

the age of 1 year. One might imagine that the

 

incidence would be higher in females because

 

of the anatomical risk factors, but this is not

 

the case and the incidence of E.coli bacteraemia

 

is generally higher in males. However, among

 

those aged 1?14 and 15?44 years, the rates were

 

higher among females. This may be explained

 

in part by personal hygiene in babies and

 

girls, and sexual activity in the 15?44 yearold age group. It has also been demonstrated

 

that there are seasonal variations in incidence

 

of bacteraemia, with increased rates during

 

summer months, particularly among older Source: Public Health England, 2014a 158 people (Eber et al, 2011) possibly as a result of

 

increased dehydration.

 

Before 2011, the reporting of the incidence

 

of E.coli bacteraemia was voluntary, but owing

 

to concerns about rising incidence, reporting

 

became mandatory for all NHS organisations

 

in 2011. However, reporting is only required

 

by NHS organisations (acute trusts and clinical

 

commissioning groups (CCGs) and does not

 

include private hospitals or care homes. Data

 

are reported monthly and annually by CCG

 

and acute trusts, and are published on the PHE

 

website. The latest figures for acute trusts across

 

London are presented in Table 1 to illustrate

 

the data available, although the same could be

 

presented for any region of the country. London

 

has been selected for the purpose of this paper

 

as London NHS organisations have the highest

 

number of cases of E. coli bacteraemia. For

 

community organisations, the total number of

 

cases per CCG is reported, as well as the number

 

of cases per 100?000 population. The average

 

number of cases per 100?000 population across

 

CCGs in England is for 2013?14 is 64.1.

 

For acute trusts, reporting is of the total

 

number of cases per trust only. In London the

 

lowest rate was reported from Moorfields Eye

 

Hospital (n=0), while the highest was from

 

Barts Health (n=664), with the average across

 

London n=198. These figures need to be read

 

with caution, however, and there are certain

 

caveats that need to be applied, for example,

 

the figures for some trusts are reported at a

 

time when mergers between different trusts

 

have taken place, and it is not clear how

 

the incidence was broken down among the

 

different sites (PHE, 2014a). Antibiotic resistance

 

Concern has been raised over increasing

 

antibiotic resistance, with some cases of

 

E. coli bacteraemia reported to be resistant to

 

ciprofloxacin and/or gentamicin (PHE, 2014b).

 

There has been very little change in resistance

 

to these drugs since 2009, and resistance to

 

ciprofloxacin and gentamicin in 2013 remains

 

very similar to 2012 (PHE, 2014b) as shown in

 

Table 2. Resistance to ciprofloxacin decreased

 

early in the 2009?13 period, but has since

 

levelled off. Resistance to the third-generation

 

cephalosporins (ceftazidime and cefotaxime)

 

remains stable at 10?11% (PHE, 2014b).

 

A number of factors have been shown to

 

contribute to the increased risk of antibiotic

 

resistance (Ben-Ami et al, 2009), including: British Journal of Nursing, 2015, Vol 24, No 3 © 2015 MA Healthcare Ltd T he genus of bacteria, Echerichia, is named

 

after Dr Theodor Escherich who isolated

 

the species (Gould, 2011). Escherichia

 

organisms are rod-shaped, Gram-negative

 

bacilli that commonly inhabit the large

 

intestine (E. coli) and are naturally excreted in

 

faeces. The urinary tract is the most common

 

site of E. coli infection and more than 90%

 

of all uncomplicated urinary tract infections

 

(UTIs) are caused by E. coli infection

 

(Madappa, 2014), particularly in women

 

because of the proximity of the urethra to the

 

anus (Gould, 2010). E. coli UTIs are caused by

 

uropathogenic strains of E. coli. COMMENT a care home resident

 

UTI

 

?? Hospital isolation >7 days in the last 6 months

 

?? Unresolving urinary symptoms

 

?? Recent travel (especially health-related) to a

 

country with increased antimicrobial resistance

 

(outside Northern Europe and Australasia)

 

?? Previous known UTI-resistant to

 

trimethoprim, cephalosporins or quinolones.

 

A small but growing number of E. coli

 

have also been found to be resistant to

 

carbapenems (PHE, 2014b), however, most

 

isolates tested against either imipenem or

 

meropenem were reported susceptible. Most

 

cases of resistance were not from blood

 

samples and therefore these strains had not

 

normally resulted in bacteraemia, but this is a

 

concern for the future.

 

?? Recurrent Prevention of E. coli bacteraemia

 

A 6-month prospective study evaluated the

 

preventability of Gram-negative bacteraemias

 

(Enoch et al, 2013). During the study period

 

141 bacteraemias in 118 patients were recorded

 

(some infections were counted more than once

 

in the same patient each time blood cultures

 

were taken) and E. coli was the most frequently

 

isolated organism. A total of 35 (28.7%) of

 

these originated in a community setting and

 

24 (19.7%) had an onset in a hospital. In total,

 

63 (51.6%) of the bacteraemias were found to

 

be healthcare associated. Several factors were

 

found to be associated with preventability, with

 

the most common being the presence of a

 

urinary catheter or central venous catheter, and

 

patients in a dependent functional state.

 

A total of 24 (20%) were thought to be

 

preventable, especially in patients with urinary

 

catheters. The presence of a urinary catheter

 

promotes the build-up of a biofilm (a living

 

layer of bacteria on the catheter) and increases

 

the risk of a UTI owing to an increased risk of

 

pathogenic organisms colonising the bladder

 

and urine (Muzzi-Bjornson and Macera, 2011).

 

It has been shown that over 40% of individuals

 

developing a UTI had been catheterised within

 

the preceding 7 days (Health Protection Agency,

 

2012). This lends weight to the argument

 

that reducing urinary catheterisation could

 

reducing UTIs (Meddings et al 2013) and

 

thereby reduce the risk of E. coli bacteraemia.

 

All nurses have a responsibility to reduce the

 

risk of patients developing E. coli bacteraemia. Table 2. Antibiotic resistance

 

Drug % resistance 2012 % resistance 2013 Ciprofloxacin and gentamicin 19 18 Cephalosporins (ceftazidime and cefotaxime) 10-11 10-11 Source: Public Health England, 2014b Catheterisation is a common procedure

 

undertaken hundreds of times every day by

 

nurses in a variety of healthcare settings in the

 

UK. It is estimated that around 25% of the

 

9 million adults treated by the NHS every year

 

will be catheterised at some point (Nazarko,

 

2009). Of course, the easiest way to prevent

 

catheter-associated UTI is not to insert an

 

indwelling catheter in the first place, and there

 

is evidence that up to 25% of catheterisations

 

are unnecessary (Fakih et al, 2010). However,

 

catheterisation is sometimes a necessary evil

 

and if this is the case the catheter should be

 

removed as soon as possible once it is no longer

 

required. Targeted surveillance of people with

 

urinary catheters may be required (Enoch et

 

al, 2013), particularly if there are other risk

 

factors for the development of a bacteraemia.

 

In addition, use of lubricant to reduce trauma

 

on catheterisation is recommended (National

 

Institute for Health and Care Excellence,

 

2012), which will help to reduce the risk of

 

infection, although these recommendations are

 

not always followed (Woodward, 2010).

 

Generally speaking, the need to reduce

 

urinary catheter usage is increasingly being

 

understood and acted upon. Yet, while the

 

number of catheterisations is decreasing, the

 

number of reported cases of E. coli bacteraemia

 

is not. Clearly there are other risk factors that

 

contribute to the development of bacteraemia.

 

Nurses are ideally placed to educate patients

 

about other simple interventions to reduce the

 

risk, such as advising girls and women to wipe

 

from front to back after passing urine, advising

 

sexually active females to pass urine following

 

intercourse, and advising on adequate fluid

 

intake, particularly in the summer months.

 

Further research is required to understand both

 

the risk factors and effectiveness of different

 

BJN

 

preventative interventions. with extended-spectrum beta-lactamase-producing

 

enterobacteriaceae in nonhospitalized patients. Clin Infect

 

Dis 49(5): 682?90. doi: 10.1086/604713

 

Eber MR, Shardell M, Schweizer ML, Laxminarayan R,

 

Perencevich EN (2011) Seasonal and temperatureassociated increases in gram-negative bacterial bloodstream

 

infections among hospitalized patients. PLoS ONE 6(9):

 

e25298. doi: 10.1371/journal.pone.0025298

 

Enoch DA, Mlangeni DA, Ekundayo J et al (2013) Gram

 

negative bacteraemia?are they preventable and what will

 

E. coli surveillance add? Journal of Infection Prevention 14(2):

 

54?9. doi: 10.1177/1757177412470014

 

Fakih MG, Pena ME, Shemes S et al (2010) Effect of

 

establishing guidelines on appropriate urinary catheter

 

placement. Acad Emerg Med 17(3): 337?40. doi:

 

10.1111/j.1553-2712.2009.00677.x

 

Gould D (2010) Causes, prevention and treatment of

 

Escherichia coli infections. Nurs Stand 24(31): 50?6. doi:

 

10.7748/ns2010.04.24.31.50.c7692

 

Gould D (2011) Escherichia coli recognition and

 

prevention. Primary Health Care 21(8): 32?9. doi: 10.7748/

 

phc2011.10.21.8.32.c8738

 

Health Protection Agency (2012) English National Point

 

Prevalence Survey on healthcare-associated infections and

 

antimicrobial use. http://tinyurl.com/l6bd788 (accessed 29

 

January 2015)

 

Khasriya R, Sathiananthamoorthy S, Ismail S et al (2013)

 

Spectrum of bacterial colonization associated with

 

urothelial cells from patients with chronic lower urinary

 

tract symptoms. J Clin Microbiol 51(7): 2054?62. doi:

 

10.1128/JCM.03314-12

 

Madappa T (2014) Escherichia coli infections. http://tinyurl.

 

com/qfxuocb (accessed 29 January 2015)

 

Meddings J, Rogers MAM, Krein SL, Fakih MG, Olmsted

 

RN, Saint S (2014) Reducing unnecessary urinary

 

catheter use and other strategies to prevent catheterassociated urinary tract infection: an integrative review.

 

BMJ Qual Saf 23(4): 277?89. doi: 10.1136/bmjqs-2012001774

 

Muzzi-Bjornson L, Macera L (2011) Preventing infection

 

in elders with long-term indwelling urinary catheters. J

 

Am Acad Nurse Pract 23(3): 127?34. doi: 10.1111/j.17457599.2010.00588.x

 

National Institute for Health and Care Excellence (2012)

 

Infection: Prevention and control of healthcare-associated

 

infections in primary and community care. http://tinyurl.

 

com/kbjz3ob (accessed 5 February 2015)

 

Nazarko L (2009) Providing effective evidence-based catheter

 

management. Br J Nurs 18(7): S4?8. doi: 10.12968/

 

bjon.2009.18.Sup3.41663

 

Public Health England (2014a) Results from the mandatory

 

surveillance of Escherichia Coli. http://tinyurl.com/mst8d7b

 

(accessed 30 January 2015)

 

Public Health England (2014b) English surveillance programme

 

for antimicrobial utilisation and resistance (ESPAUR). http://

 

tinyurl.com/pvbcmlx (accessed 5 February 2015)

 

Rosen DA, Hooton TM, Stamm WE, Humphrey PA,

 

Hultgren SJ (2007) Detection of intracellular bacterial

 

communities in human urinary tract infection. PLoS Med

 

4(12): e329. doi: 10.1371/journal.pmed.0040329

 

Woodward S (2010) The need for best practice in

 

catheterization. Br J Nurs 19(12): 740. doi: 10.12968/

 

bjon.2010.19.12.48650 Anderson GG, Palermo JJ, Schilling JD et al (2003)

 

Intracellular bacterial biofilm-like pods in urinary tract

 

infections. Science 301(5629): 105?7. doi: 10.1126/

 

science.1084550

 

Ben-Ami R, Rodríguez-Baño J, Arslan H et al (2009)

 

A multinational survey of risk factors for infection Sue Woodward Lecturer, Florence Nightingale Faculty of Nursing

 

and Midwifery, King?s College London Have an idea for BJN? ( 020 7738 5454 8 [email protected]

 

160 @BJNursing

 

British Journal of Nursing, 2015, Vol 24, No 3 © 2015 MA Healthcare Ltd ?? Being Copyright of British Journal of Nursing is the property of Mark Allen Publishing Ltd and its

 

content may not be copied or emailed to multiple sites or posted to a listserv without the

 

copyright holder's express written permission. However, users may print, download, or email

 

articles for individual use.

 







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