MRSA Bloodstream Infections Continue to Fall in the UK

The Health Protection Agency in the United Kingdom has released its latest quarterly figures on methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections and Clostridium difficile infections in the UK. These relate to the January to March 2008 period, the final quarter in the 2007/2008 financial calendar, providing annual figures for both infections.

The latest figures on MRSA bloodstream infections show that there were 966 cases reported in England during the January to March quarter of 2008. This represents an 11 percent decrease on the previous quarter (October to December 2007) when 1,088 reports were received.

There was a 30 percent decrease in the number of cases reported in financial year 07/08 (4,438) compared to financial year 06/07 (6,383). This is the fourth annual decrease in such bloodstream infection cases and the most marked.

Dr. Georgia Duckworth, head of the Agency’s Healthcare-Associated Infection and Antimicrobial Resistance Department, said, “The substantial drop we have seen in MRSA bloodstream infections over the past year is impressive and a credit to the hard work of our colleagues in the NHS, strengthening good practice in infection control. If we are to continue this reduction in healthcare-associated infections it is vital that the measures which have won this significant success remain in place and that the public and healthcare workers recognize their importance.”

The latest C. difficile figures show that there were 10,586 cases reported in patients aged 65 years and over between January and March 2008. This represents a 6 percent increase in reported cases in this age group from the previous quarter, October to December 2007, (9,993 cases) but reflects a 32 percent reduction on the same quarter last year (15,644 cases).

Historically, annual figures for C.difficile have been collated and presented in calendar year format. However, as the new Public Service Agreement on reducing C.difficile infection is based on financial year figures from 2007/08, future annual figures released by the Agency will be presented by financial year.

Both are available this year, as part of the transition from calendar to financial year reporting:

Between January and December 2007 there were 50,392 cases of C.difficile reported in patients aged 65 years and over. This represents a 9 percent decrease on the previous calendar year when 55,635 cases were reported (between January and December 2006).

Between April 2007 and March 2008 there were 45,334 cases of C.difficile reported in patients aged 65 years and over.

Duckworth added, “Although there has been mandatory reporting of C.difficile since 2004, this past year has seen major changes to improve the reporting system. We now have a more robust system that will enable us to measure the levels of this infection better and help Trusts manage and monitor the effectiveness of their interventions to improve infection control.”

The Health Protection Agency also released its third annual report, “Surveillance of Healthcare Associated Infections 2008,” examining the current picture of healthcare-associated infections in England. The report highlights that last year’s confidence that the downward trend in MRSA bloodstream infections would be sustained was not misplaced, with infections continuing to fall across all regions.

It also reports on the early indications that C.difficile infections are falling but, given the significant changes to improve the mandatory surveillance of the C.difficile reporting system, cautions that more time is required to assess whether these falling numbers herald the same type of downturn seen for MRSA bloodstream infections.

In addition, it demonstrates that there have been significant decreases in rates of surgical site infections (SSIs) in the main orthopedic categories and that English rates of surgical site infection are comparable to those elsewhere in Europe. There has been growing participation in SSI surveillance since 2003, with 224 hospitals collecting data in 2007on 83,444 surgical procedures across ten categories of surgery. 898 SSIs were identified with rates of SSIs ranging from 0.5 to 0.75 infections per 1,000 post-operative days. Rates were found to be highest in surgery where the likelihood of microbial contamination at the surgical site is high e.g. bowel surgery.

The report highlights work in progress, such as outbreak surveillance and areas warranting further attention, like surveillance of particularly vulnerable groups of patients, for instance those in critical care units.

Peter Borriello, director of the Agency’s Centre for Infections, said, “It is worth remembering that not all healthcare-associated infections are preventable. However, this shouldn’t lead to complacency around tackling the infections that are preventable and engaging in the battle to continually drive down rates of healthcare-associated infections. These figures show that there can be, and have been, significant reductions.”

Source: Health Protection Agency