Trends in Bacteraemia and C. difficile Infection in England

Dawn O'Shea

December 08, 2020

New figures from Public Health England (PHE) show that rates of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium difficile (CDI) infection are continuing to decrease year-on-year, although there have been some relatively small increases in more recent years.

The MRSA, MSSA and Gram-negative bacteraemia and CDI annual report shows that these large declines in MRSA bacteraemia and CDI occurred in both community and hospital setting.

In contrast, Escherichia coli and methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia rates have increased, with the most prominent rises seen in community-onset cases. MSSA showed a small increase in hospital-onset cases, but for E. coli this has been relatively static.

Over time, the community-onset component has accounted for an increasing proportion of cases, even MRSA and CDI. Although rates have reduced in both settings, the reduction has been steeper in the hospital setting. It is estimated that a large proportion of the community-onset infections (up to 50% in the case of E. coli) have had recent health care interactions, including prior hospital stay in the 28 days before infection onset.

The report suggests increasing focus on community interventions and improving infection control at the interface between hospital and community will be required if significant reductions are to be achieved.

Rates of E. coli bacteraemia have shown a year-on-year increase from the beginning of the surveillance period (2012-2013); however, in 2019-2020, the rate had remained stable at 77.3 cases per 100,000 population. This is the second time the rate has remained stable for E. coli bacteraemia, the decline in the cases started in 2017-2018.

After E. coliKlebsiella spp and Pseudomonas aeruginosa are the most common causative organisms in gram-negative bacteraemia in England, but cause substantially lower rates of bacteraemia than E. coli. Rates of Klebsiella spp. increased from 19.1 in 2018-2019 to 19.7 in 2019-2020. Rates of P. aeruginosa bacteraemia increased slightly, from 7.5 in 2018-2019 to 7.7 in 2019-2020.

Urinary tract infection remained the most important primary focus across these infections, ranging from 30.9 to 48.2 per cent of reported sources.

Rates of MSSA bacteraemia increased marginally from 21.6 cases per 100,000 population in 2018-2019 to 21.8 per 100,000 population in 2019-2020.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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