Planning to halve GNBSI: getting to grips with healthcare-associated E. coli BSI sources

Today, the Journal of Hospital Infection have published an article from our research group about E. coli BSI sources. The key message is that the sources of E. coli BSIs at a large teaching hospital differ considerably from the national average, with a large proportion related to febrile neutropaenia (18%) and diverse gastrointestinal sources (15%). This calls into question the ‘preventable’ proportion of these cases – and adds something to the discussion as to whether the national ambition to halve GNBSI by 2021 is feasible.

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What’s driving increases in MSSA BSI and E. coli BSI in England?

I was recently browsing through the HCAI mandatory reporting data in England (as you do) and noticed that the increasing trend in E. coli BSIs and MSSA BSIs seems to be following a similar trajectory. Could the drivers of these two distinctly different organisms be similar?

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Do single rooms prevent HCAI? This suggest suggests YES for norovirus, but no for C. difficile infection and E. coli BSI

There are pros and cons of increasing the proportion of single rooms. One of the commonly-cited pros is a reduction in HCAI. A recent UK study provides some evidence that C. difficlie infection, and MSSA /  E. coli BSIs are not reduced by a move to a hospital with more single rooms, but that norovirus control is more effective when you have more single rooms.

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Going for GNBSI

We’ll be publishing the results of the vote on whether or not we can halve HA-GNBSI by 2021 later this week. Right now, it looks like Martin is heading for a comfortable, if somewhat depressing victory (“No, we can’t halve GNBSI by 2021”) but there’s still time to ride a wave of positivity and vote with me that “Yes, we can halve GNBSI by 2021”. So, I thought that now would be an appropriate time to review the recent JHI paper that both Martin and I referred to, providing some enhanced epidemiological data on E. coli BSIs in England.

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Can we really halve Gram-negative BSIs (GNBSIs) by 2021? Kiernan vs. Otter Mk II

The UK government has recently announced their ambition to halve the rate of Gram-negative BSIs by 2021. Looking at the latest mandatory reporting dataset (see Figure 1 below), you can see why. Impressive reductions in MRSA BSI and C. difficile, but a notable increase in E. coli BSI. And this combined this with worrying data around increased antimicrobial resistance in Gram-negative bacteria from the ESPAUR report. In this post, Martin Kiernan and Jon Otter present both sides of the argument as to whether Gram-negative BSIs can be reduced by 2021, with comment from Andreas Voss and Marc Bonten! And you get to vote on which side of the argument you come down on after reading the arguments. Let battle commence…

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