Trends over time in Escherichia coli bloodstream infections, urinary tract infections, and antibiotic susceptibilities in Oxfordshire, UK, 1998–2016: a study of electronic health records  Karina-Doris Vihta, MMath, Nicole Stoesser, DPhil, Prof Martin J Llewelyn, PhD, T Phuong Quan, MSc, Tim Davies, MBBS, Nicola J Fawcett, BMBCh, Laura Dunn, MSc, Katie Jeffery, BMBCh, Prof Chris C Butler, FMedSci, Gail Hayward, DPhil, Monique Andersson, MD, Marcus Morgan, MSc, Sarah Oakley, MSc, Amy Mason, PhD, Susan Hopkins, FRCP, David H Wyllie, PhD, Prof Derrick W Crook, MBBCh, Prof Mark H Wilcox, MD, Prof Alan P Johnson, PhD, Prof Tim E A Peto, FRCP, Prof A Sarah Walker, PhD  The Lancet Infectious Diseases  Volume 18, Issue 10, Pages 1138-1149 (October 2018) DOI: 10.1016/S1473-3099(18)30353-0 Copyright © 2018 Elsevier Ltd Terms and Conditions

Figure 1 Monthly Escherichia coli bloodstream infection (A) and UTI (B) including both first and recurrent infections, by time since hospital exposure, 1998–2016 Only counting E coli bloodstream infection recurrences occurring more than 14 days after an index positive culture, and E coli UTI recurrences more than 90 days after an index positive culture. In panel B, quasi-nosocomial and nosocomial data are plotted from 0 to 250 cases because fewer cases were recorded in these populations. The line through the datapoints is the estimated incidence by iterative sequential regression (ISR). The lines at the base of the graph are 95% CIs around the breakpoints estimated by the ISR model. IRR is estimated for 2016. IRR=incidence rate ratio. UTI=urinary tract infection. The Lancet Infectious Diseases 2018 18, 1138-1149DOI: (10.1016/S1473-3099(18)30353-0) Copyright © 2018 Elsevier Ltd Terms and Conditions

Figure 2 Estimated relative change in incidence for Escherichia coli bloodstream infections (A), E coli UTIs (B), and severity of co-amoxiclav-resistant and co-amoxiclav-susceptible E coli bloodstream infections (C) IRR points are estimated for 2016, with 95% CI as error bars. Severity of infection is measured by use of 30-day mortality and concentration of C-reactive protein and given as RR. Previous UTI means a UTI 3 days or more previously. Numbers and heterogeneity tests are in the appendix (p 9). IRR=incidence rate ratio. RR=rate ratio. UTI=urinary tract infection. The Lancet Infectious Diseases 2018 18, 1138-1149DOI: (10.1016/S1473-3099(18)30353-0) Copyright © 2018 Elsevier Ltd Terms and Conditions

Figure 3 Escherichia coli bloodstream infection according to time since hospital exposure and urinary tract infection contribution, 1998–2016 (A) Annual proportion of samples submitted. (B) Number of cultures submitted per year, definitions in appendix (p 3). The Lancet Infectious Diseases 2018 18, 1138-1149DOI: (10.1016/S1473-3099(18)30353-0) Copyright © 2018 Elsevier Ltd Terms and Conditions

Figure 4 Annual number of Escherichia coli bloodstream infections susceptible (A) and resistant (B) to co-amoxiclav, and antibiogram of susceptibility (C), by hospital-exposure group, 1998–2016 Annual IRR estimated in 2016. All co-amoxiclav susceptible IRR 1·03, 95% CI 1·02–1·04; p<0·0001; all co-amoxiclav resistant IRR 1·14, 95% CI 1·09–1·18; p<0·0001.IRR=incidence rate ratio. R=resistant. S=susceptible. The Lancet Infectious Diseases 2018 18, 1138-1149DOI: (10.1016/S1473-3099(18)30353-0) Copyright © 2018 Elsevier Ltd Terms and Conditions