Escherichia coli causes more bacteraemia cases in England than any other bacterial species and gram-negative bloodstream infections are believed to have contributed to approximately 5,500 NHS patient deaths in 2015. While we know that Escherichia coli is a considerable burden to the NHS and that antimicrobial resistance is a further complicating factor, quantifying its impact is difficult.

Our work, therefore, sought to estimate the impact of Escherichia coli bacteraemia on patient in-hospital mortality and length of stay and to estimate the effect of antibiotic resistance on these outcomes. The results of this research were used by NHS Improvement to develop an indicative tool showing NHS providers and commissioners how many infections are occurring on a local level.

The tool provides trust-level costing and excess mortality due to these infections by utilising the estimates of excess length of stay and mortality from our work and aims to help trusts and CCGs understand better the scale of the impact of Escherichia coli bloodstream infections in their institution which in turn can then be used to calculate the potential benefits of any policies to reduce Escherichia coli bloodstream infections.


Naylor NR, Silva S, Kulasabanathan K, Atun R, Zhu N, Knight GM, Robotham J., Methods for estimating the burden of antimicrobial resistance: a systematic literature review protocolSystematic Reviews, 2016 Nov 8;5(1):187

Naylor NR, Atun R, Zhu N, Kulasabanathan K, Silva S, Chatterjee A, Knight GM, Robotham JV., Estimating the burden of antimicrobial resistance: a systematic literature review, Antimicrobial Resistance and Infection Control. 2018 Apr 25;7:58.

Naylor NR, Zhu N, Hulscher M, Holmes A, Ahmad R, Robotham JV., Is antimicrobial stewardship cost-effective? A narrative review of the evidence, Clinical Microbiology and Infection. 2017;23(11):806-11.