• MRSA bacteraemia, Clostridium difficile and GRE bacteraemia data published

• HIV guidance on post-exposure prophylaxis (PEP) – update

MRSA bacteraemia, Clostridium difficile and GRE bacteraemia data published

Quarterly (January to March 2007), six monthly (October 2006 to March 2007) and annual (April 2006 to March 2007) data collected from the mandatory surveillance of MRSA bacteraemia in England have been released this week [1]. Data for January to March 2007 show that there were 1,444 reports of MRSA bacteraemia, which is a 6.4% decrease on the 1,542 cases recorded for October to December 2006. In the six months between October 2006 and March 2007 there were 2,986 reports of MRSA bacteraemia, this represents a 12% decrease from the 3,392 reports in the previous six month period. During the year April 2006 to March 2007 6,378 cases of MRSA bloodstream infection were reported. This is a decrease of 10% over the same period in 2005/06, when there were 7,096 reports. The rate of reported cases of MRSA bacteraemia per 10,000 bed-days for 2006/07 was 1.59. This compares to a rate of 1.77 cases per 10,000 bed-days reported for 2005/06.

New data from the MRSA bacteraemia enhanced surveillance scheme have also been published. The enhanced surveillance scheme enables the collection of more detailed information such as age, sex and treatment speciality. Age distribution clearly shows that MRSA bacteraemia occurs more frequently among men and the elderly. Seventy-seven per cent of MRSA bacteraemia were reported to have occurred in those aged 60 years and over. Almost two thirds of MRSA bacteraemia cases over the past year were detected two or more days after admission to the reporting trust, implying that infections were acquired during the hospital admission. Amongst the ten most frequently selected specialties for patients whose MRSA bacteraemia was detected two or more days after admission, the highest rates (per 10,000 bed-days) are in Nephrology (3.24) and Gastroenterology (2.32) whereas the lowest rates amongst these ten specialties can be found in Trauma and Orthopaedics (0.50) and Cardiology (0.42).

The latest quarterly (January to March 2007) mandatory reporting of C. difficile in patients aged 65 and over shows that there were 15,592 cases recorded. This figure represents a 2% rise when compared to the same period last year (January to March 2006), when 15,342 cases were reported. Yearly data will next be published in April 2008.

The latest annual (October 2005 to September 2006) reporting of glycopeptide-resistant enterococcal (GRE) bacteraemia shows that there were 903 reports during this period. This represents an increase of 19% from the 758 cases reported between October 2004 and September 2005.

Figures for MRSA bacteraemia and C. difficile will continue to be published on a quarterly basis as part of the commitment to open reporting. GRE bacteraemia will continue to be reported on an annual basis.

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 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>.

HIV guidance on post-exposure prophylaxis (PEP) – update

Following the Medicines and Healthcare products Regulatory Agency (MHRA) alert on the recall of all batches of Viracept products [1], the Chief Medical Officer for England has circulated an update to the guidance of the Expert Advisory Group on AIDS (EAGA) on post-exposure prophylaxis (PEP).

The recall of the antiretroviral Viracept (nelfinavir) from the European market in June 2007 has implications for PEP, since Viracept is the currently recommended protease inhibitor component of PEP starter packs. EAGA has therefore recommended an update to its HIV PEP guidance, as an interim measure pending a complete update of the guidance, which is in preparation.

EAGA recommends that Kaletra (lopinavir/ritonavir) tablets be substituted for Viracept in PEP starter packs. In preliminary discussions regarding changes to the recommended PEP starter pack, EAGA had already concluded that Kaletra (tablet formulation) should be the preferred protease inhibitor.

The CMO letter ( CEM/CMO/2007/16 ), containing further detailed information, can be accessed at http://www.info.doh.gov.uk/doh/embroadcast.nsf/vwDiscussionAll/1D1582812A934F1A80257322002ED694

References
1. Class 1 Drug Alert (action now - including out of hours): Contaminated originator and parallel distributed product - Viracept (nelfinavir mesilate) - EL(07)A/10. MHRA website [online], 6 June 2007 [accessed 25 July 2007]. Available at < http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary=true&ssDocName
=CON2031377&ssTargetNodeId=364 >.