Can we halve GNBSI? The crowd say no…!

I participated in another pro-con debate recently up against fellow Reflections blogger Martin Kiernan during a Webber Teleclass. The question for the debate was “Can we halve Gram-negative BSI?” (I was arguing that we can). We ran a live Twitter poll and the outcome: 59% of the 22 respondents voted that no, we can’t halve GNBSI.

The slides from my talk are here.

My argument had two main themes: that there is a sizeable preventable portion of GNBSI and we have a lot to go for, and that we need a new approach to preventing GNBSI that will require new models of collaborative working across acute and non-acute health and social case.

The image below maps out the drivers of GNBSI. Some of these are modifiable (e.g. hydration and UTI, devices, antimicrobial stewardship), and some are not (e.g. deprivation [ok technically modifiable but beyond the scope of most IPC teams!], seasonal variation). The aim here is to identify those drivers of GNBSI that are modifiable and come up with practical interventions that could make a big difference.

Figure: Drivers of Gram-negative BSI.

Hydration is a good example. The most common source of E. coli BSI (which accounts for most GNBSI) is UTIs. We know that poor hydration is an important risk factor for UTI. So if we can improve hydration – in hospitals and outside – then there’s a good chance we’ll reduce UTI and in doing so reduce E. coli BSI.   

Antimicrobial stewardship is another. If we can improve the management of Gram-negative infections in the community through appropriate therapy outside of hospital admissions, then you reduce the chance that they’ll progress to a GNBSI.

I can’t tell you for sure that we can halve GNBSI. But we must try to prevent the preventable GNBSIs!

Single rooms for ESBLs anyone?

A comprehensive and impressive cluster randomised crossover study published in Lancet ID examines whether it makes sense to use single rooms (as compared with multi-bed bays) to apply contact precautions for patients known to be carrying ESBL-Enterobacteriaceae. I need to be careful what I say, because fellow bloggers Marc and Andreas are co-authors. However, the gist seems to be: don’t bother with single rooms for ESBL-E carriers – but many hospitals don’t have capacity to do that anyway, so this may not be a practice-changing finding in many parts of the world!

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Who’s going to go for GNBSI? A reflection from HIS 2018

I attended a thought-provoking session at the recent Healthcare Infection Society (HIS) conference in Liverpool on reducing GNBSI (you can download some of the speaker abstracts here). It seems that the hefty majority of E. coli BSIs are rooted in issues outwith the walls of acute hospitals. So the question is, who’s going to tackle these issues to prevent GNBSI? Who’s going to go for GNBSI (sorry, couldn’t resist another pop-culture reference to the ‘80s – who could forget ‘Going for Gold’ with Henry Kelly).

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Can we halve Gram-negative BSIs by 50% by 2021? The crowd say “No”

Most of those casting their vote supported Martin’s (somewhat pessimistic) view that we can’t halve Gram-negative BSI by 2021 (see the figure, below).  Let me first give you my own, unspoiled opinion (written before the results of this survey were known).  I was intending to vote for option 3 (the English can’t, the Dutch might) but I am not even sure of that; actually, I believe that neither the English nor the Dutch can.

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ESPAUR 2016: an early Christmas present


I am just getting around to reading (well detail-scanning the exec summary) of the ESPAUR report. My main reflection is what a fantastic resource this reporting stream offers us: to have freely accessible, regular, accurate, national data on antimicrobial resistance and usage, and other related indicators is pretty unique!

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Halving GNBSI


The Department of Health announced last week their intention to halve the rate of E. coli BSI by 2020. Whilst this is a move that should be embraced, it will be an enormous challenge to achieve. The reduction that has been delivered with MRSA BSI could be seen as a model for success (and I suspect that if you were a politician, you would see it this way). However, it is vital to recognise that E. coli BSI and, more broadly, Gram-negative BSI (GNBSI) are not the same as MRSA BSI, and will require a different reduction strategy.

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