直到最近，医疗机构相关的大肠杆菌败血症一直是感染预防和控制的忽视领域，尽管其30天病死率达到15-20%。最近，英国卫生部制定了一个目标，以在五年内将医院获得性大肠杆菌败血症发病率减少50%。本研究旨在通过实施多维度干预措施来确定其对实现这一目标的影响。从2017年4月到2022年3月，在Barts Health NHS Trust内，对连续的医院获得性大肠杆菌败血症住院患者进行了前瞻性研究。利用质量改进方法学和在每个阶段实施计划、执行、研究、行动（PDSA）循环，修改高风险手术的抗生素预防措施，并引入与医疗设备相关的“良好实践”干预措施。分析了败血症患者的特征，并记录了败血症发作的趋势。利用Stata SE（版本16）进行了统计分析。共有770名患者和797例医院获得性大肠杆菌败血症。在2017-18年的134例基线之后，此数字在2019-20年达到194例峰值，然后在2020-21年和2021-22年下降至157例和159例。大多数医院获得性大肠杆菌败血症发生在年龄>50岁的人群中，占551例（69.1%），其中年龄>70岁的人数最多，占292例（36.6%）。医院获得性大肠杆菌败血症更常见于10月至12月之间。大多数事件发生在内科或老年护理患者（345例，43.3%）、专科手术（141例，17.7%）、血液学/肿瘤科（127例，15.9%）和需要重症监护的患者（108例，13.6%）中。泌尿道是感染最常见的部位，占336例（42.2%），其中包括导尿管和非导尿管相关的感染。175例（22.0%）的大肠杆菌败血症分离物产生了广谱β-内酰胺酶（ESBL）。共有315例（39.5%）对氨苄西林/克拉维酸、246例（30.9%）对环丙沙星和123例（15.4%）对庆大霉素耐药。在7天内，有77名患者死亡（9.7%；95% CI 7.4-12.2%），到30天时上升至129例（16.2%；95% CI 13.7-19.9%）。尽管实施了质量改进干预措施，但是从基线上无法实现50%的减少，尽管从2019-20年开始实现了18%的减少。我们的工作强调了抗菌药物预防和医疗设备“良好实践”的重要性。随着时间推移，如果这些干预措施得到适当的实施，则进一步减少医疗机构相关的大肠杆菌败血症感染是可能的。©2023年作者。

Until recently, healthcare-associated E. coli bacteraemia was a neglected area of infection prevention and control (IPC), despite a 30-day mortality of 15-20%. Recently, the UK Department of Health (DH) introduced a target to reduce hospital-acquired E. coli bacteraemias by 50% over a five-year period. Following implementation of multifaceted and multidisciplinary interventions, the aim of this study was to determine its impact on achieving this target.From April 2017 to March 2022, consecutive hospital-acquired E. coli bacteraemic inpatients within Barts Health NHS Trust were prospectively studied. Using quality improvement methodology, and implementing the plan, do, study, act (PDSA) cycle at each stage, antibiotic prophylaxis for high-risk procedures were modified and 'good practice' interventions around medical devices introduced. Characteristics of bacteraemic patients were analysed and trends in bacteraemic episodes recorded. Statistical analysis was undertaken in Stata SE (version 16).There were 770 patients and 797 episodes of hospital-acquired E. coli bacteraemias. Following a baseline of 134 episodes in 2017-18, this peaked at 194 in 2019-20 before dropping to 157 in 2020-21 and 159 in 2021-22. Most hospital-acquired E. coli bacteraemias occurred in those aged > 50, 551 (69.1%), with the highest proportion occurring in those age > 70, 292 (36.6%). Hospital-acquired E. coli bacteraemia occurred more commonly between October to December.Most episodes occurred in either medicine or care of the elderly patients, 345 (43.3%), specialist surgery, 141 (17.7%), haematology/oncology, 127 (15.9%) and patients requiring critical care, 108 (13.6%). The urinary tract, 336 (42.2%), both catheter and non-catheter associated, was the commonest sites of infection. 175 (22.0%) of E. coli bacteraemic isolates were extended spectrum beta lactamase (ESB) producing. Co-amoxiclav resistance was 315 (39.5%), ciprofloxacin resistance 246 (30.9%) and gentamicin resistance 123 (15.4%). At 7 days, 77 patients (9.7%; 95% CI 7.4-12.2%) died and by 30 days this had risen to 129 (16.2%; 95% CI 13.7-19.9%).Despite implementation of quality improvement (QI) interventions, it was not possible to achieve a 50% reduction from baseline although an 18% reduction was achieved from 2019-20 onwards. Our work highlights the importance of antimicrobial prophylaxis and medical device 'good practice'. Over time, these interventions, if properly implemented, could further reduce healthcare-associated E. coli bacteraemic infection.© 2023 The Authors.