E. coli bacteraemia case counts and rates of community-onset, by sub ICB location (SICBL) and year

Laboratory confirmed cases of E. coli bacteraemia. Community-onset cases are all those that are not hospital-onset cases. Hospital-onset is determined on patient location, date of admission, date of specimen, and patient category. Hospital onset is only indicative for cases where NHS patient specimens are taken on the third day of admission onwards (e.g., day three when day one equals day of admission) at an acute trust (including cases with unspecified specimen location) for inpatients, day patients, emergency assessment, or unspecified patient category. Records with a missing admission date (where the specimen location is acute trust or missing and the patient category is inpatient, day patient, emergency assessment, or unspecified) are also included. Other cases may have hospital onset, but not in acute trusts. Data is available by Sub ICB ([Integrated Care Board]) location. ## Rationale Escherichia coli (E. coli) is a Gram-negative bacterium and has been the predominant cause of bacteraemia in England, Wales, and Northern Ireland, overtaking those caused by S. aureus (a Gram-positive bacterium), since 2003. Following a year-on-year increase in Gram-negative bacteraemia, as reported to UKHSA via the voluntary surveillance system (44% increase among E. coli bacteraemia alone between 2003 and 2011, from 16,542 to 29,777 voluntary reports), and a recommendation from the government advisory group Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections to commence E. coli bacteraemia surveillance, the Department of Health mandated NHS acute Trusts to report patient-level data on episodes of E. coli bacteraemia to PHE through the established enhanced mandatory surveillance Data Capture System from June 2011. A low value is indicative of a low rate of E. coli. ## Caveats These data do not provide a basis for decisions on the clinical effectiveness of infection control interventions in individual Trusts: further investigations considering potential confounders would need to be undertaken before this could be done. Nor do these data provide a basis for comparisons between acute Trust or sub ICB locations (SICBL). Rate information, using rate calculations as currently defined, is not appropriate for comparison. The counts of infections have not been adjusted to give a standardised rate considering factors such as organisational demographics or case mix. Rate information is of use for comparison of an individual organisation over time. ‘All reported cases’ refers to all E. coli positive blood cultures reported by the Trust whose laboratory processes the specimen. It is important to note that this does not necessarily imply that the infection was acquired there. Confidence intervals for rates are not currently calculated because appropriate methods for comprehensive coverage are being assessed. Cases that the UKHSA’s HCAI Data Capture System attributes to a commissioning hub (such as the national commissioning hub, 13Q, or one of the regional Health & Justice commissioning hubs) are not featured in sub ICB Location dashboards but they do still contribute to the highest spatial level—the England national total. This means the England case total & rates may be slightly higher than the sum of all sub ICB Location cases & rates.