• Quarterly Clostridium difficile and MRSA data published
  
• Wound Botulism among injecting drug users in the UK: an update
  
  

Quarterly Clostridium difficile and MRSA data published

Quarterly (October to December 2006) and annual (January to December 2006) data collected from the mandatory surveillance of Clostridium difficile in patients aged 65 year and over in England have been released [1]. Data for October to December 2006 show there were 12,814 cases of C. difficile, which is a 0.2% decrease on the 12,838 cases recorded for July to September 2006. During the year January to December 2006 there were 55,681 cases of C. difficile. This is an increase of 8% over the same period in 2005, when there were 51,767 cases reported. This contrasts favourably with the 17% increase in reported cases between 2004 and 2005. The rate of reported cases of Clostridium difficile per 1000 bed-days for patients aged 65 and over in 2006 was 2.39. Rates of infection remain high across England, particularly in small acute trusts, and the results show clearly the scope for improvement.

The latest quarterly (October to December 2006) mandatory MRSA bacteraemia data show that there were 1542 MRSA bloodstream bacteraemias reported, down 7% from the previous quarter (July to September 2006), when 1652 cases were reported. Yearly (April 2006 to March 2007) and six-monthly (October 2006 to March 2007) data for MRSA will be published in July 2007.
Figures for C. difficile and MRSA will continue to be published on a quarterly basis as part of the commitment to open reporting. Different starting dates for the mandatory surveillance systems means that the data for the two organisms will continue to cover different periods.

The HPA’s MRSA bacteraemia enhanced surveillance web-enabled system has recently been redesigned to allow the inclusion of C. difficile in addition to MRSA bacteraemia data [2]. This system has been available since 2 April and enables Trusts and PCTs to monitor progress towards meeting local targets. Starting from April, data for C. difficile will now include patients aged 2 years and older and will be collected monthly instead of quarterly, to support monitoring of the infection. The HPA will, however, continue to publish these figures quarterly as it has since January.

References
1. Quarterly reporting results for Clostridium difficile infections and MRSA Bacteraemia. April 2007. Health Protection Agency website [online]. London: Health Protection Agency, 26 April 2007 [accessed 26 April 2007]. Available at <http://www.hpa.org.uk/infections/topics_az/hai/Mandatory_Results.htm>.

2. Chief Medical Officer for England. Changes to the mandatory healthcare associated infection surveillance system for Clostridium difficile associated diarrhoea from April 2007. PLCMO (2007)4. London: Department of Health, 2007. Available at
<http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Professionalletters/
Chiefmedicalofficerletters/DH_073767>.

 

 

 

 

 

 

 

 

 

 

Wound Botulism among injecting drug users in the UK: an update

Cases of wound botulism continue to occur among injecting drug users (IDUs) in the United Kingdom (UK). Twenty-two suspected cases were reported to the Centre for Infections in 2006, fewer than in each of the previous two years, with 28 cases reported in 2005 and 40 in 2004 [1]. A total of 134 suspected cases have now been reported since the first cases were reported in 2000 [2].

Of the 22 cases in 2006, 18 were in England, three in Scotland, and one in Wales. Cases in England were distributed throughout the country with four in London, three in the North West, two in Yorkshire and the Humber, three in the East Midlands, two in the West Midlands, one in the East, and three in the South East. As with previous years, the majority of individuals were male (73%). The average age was 40 years, which is older than in previous years (demographic information has been systematically collected for cases since 2002).

Nine of the cases in 2006 were laboratory confirmed either by detection of botulinum toxin in serum or wound tissue or by isolation of Clostridium botulinum from wound tissue. Of these, six cases were identified as type-A toxin, one as type-B and in two cases both type-A and type-B toxins were detected. Laboratory procedures are insensitive and an unconfirmed laboratory result does not exclude a diagnosis of botulism. Botulinum antitoxin is effective at reducing symptoms if given early in the course of the infection. If clinical symptoms indicate botulism, the clinician should not wait for the results of microbiological testing before administering the antitoxin. C. botulinum is sensitive to benzylpenicillin and metronidazole. Surgical debridement is important to reduce the organism load and avoid relapse after antitoxin treatment.

All of the cases in 2006, where detailed patient information was provided, were admitted to hospital, the majority to intensive care. Only one individual reported that they did not have either a wound, boil or abscess present. Two individuals died, one of whom did not receive botulinum antitoxin. All of the other cases received antitoxin.

All thirteen cases for whom information about drug use was available reported injecting heroin. Wound botulism among injecting drug users has been associated with ‘skin popping’ (subcutaneous injection) and ‘muscle popping’ (intramuscular injection). Of the 12 cases who provided information about their injecting practices, only seven reported skin or muscle popping as their primary or secondary method of drug use. It is possible that the individuals who did not report skin or muscle popping injected into their muscle or skin unintentionally whilst intending to inject intravenously.

Even though wound botulism remains rare, it is now the most common clinical presentation of botulism in the UK. Further information and advice for health professionals and those working with injecting drug users is available on the HPA website [3].

References
1. Wound botulism in injecting drug users in the United Kingdom. Commun Dis Rep CDR Wkly [serial online] 2006 [accessed 25 April 2007]; 16(13): news. Available at <http://www.hpa.org.uk/cdr/archives/2006/cdr1306.pdf>

2. PHLS. Wound botulism in an injecting drug user in London. Commun Dis Rep CDR Wkly 2000; 10(20): 177,180. Available at <http://www.hpa.org.uk/cdr/archives/CDR00/cdr2000.pdf>

3. Botulism. Pages on Health Protection Agency website [online]. London: HPA, undated. Available at <http://www.hpa.org.uk/infections/topics_az/botulism/menu.htm>