Question Details

[solution] » hello can you view the article and let me know if you can help

Brief item decscription

Step-by-step solution file

Item details:

hello can you view the article and let me know if you can help

hello can you view the article and let me know if you can help me. thanks

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




?? 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




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:




Gould D (2010) Causes, prevention and treatment of


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




Gould D (2011) Escherichia coli recognition and


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




Health Protection Agency (2012) English National Point


Prevalence Survey on healthcare-associated infections and


antimicrobial use. (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:




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/




Public Health England (2014a) Results from the mandatory


surveillance of Escherichia Coli.


(accessed 30 January 2015)


Public Health England (2014b) English surveillance programme


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




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.


About this question:

This question was answered on: Feb 21, 2020

PRICE: $24 (18.37 KB)

Buy this answer for only: $24

This attachment is locked

We have a ready expert answer for this paper which you can use for in-depth understanding, research editing or paraphrasing. You can buy it or order for a fresh, original and plagiarism-free copy (Deadline assured. Flexible pricing. TurnItIn Report provided)

Pay using PayPal (No PayPal account Required) or your credit card. All your purchases are securely protected by PayPal.

Need a similar solution fast, written anew from scratch? Place your own custom order

We have top-notch tutors who can help you with your essay at a reasonable cost and then you can simply use that essay as a template to build your own arguments. This we believe is a better way of understanding a problem and makes use of the efficiency of time of the student. New solution orders are original solutions and precise to your writing instruction requirements. Place a New Order using the button below.

Order Now