Urosepsis: a growing and preventable problem?

Abstract

Public Health England data show a significant and important rise in hospital admissions and mortality rates for Escherichia coli ( E. coli ) bacteraemia over the last 12 years in England, Wales, and Northern Ireland, particularly in older patients. Although the cause is not established, some commentators have suggested that it might be due to delayed or inadequate treatment of urinary tract infections in primary care, possibly as a result of antimicrobial stewardship initiatives. Providing evidence to establish the cause of the problem is a clear research priority. Here we discuss current E. coli bacteraemia admissions data, work in progress to investigate the rise, and future actions needed to establish whether primary care clinicians are indeed well placed to tackle this growing problem. E. coli bacteraemia is the most common cause of sepsis in England, with 30-day all-cause mortality of 18%. Mandatory surveillance of E. coli bacteraemia hospitalisation in England was initiated in 2011, following increases identified by Public Health England in voluntarily reported data. Surveillance confirmed that, between April 2012 and April 2017, the annual rate of E. coli bacteraemia hospitalisation increased by 22%, from 60.4 to 73.9 reports per 100 000 population.1 To address this, the UK government aims to reduce the prevalence of health care-associated gram-negative bacteraemia by 50% by the year 2021.2 E. coli is a particular focus of this aim given that it was aetiological in 54% of all gram-negative bacteraemia in 2016.3 Secondary care treatment for sepsis typically includes …