MRSA bacteraemia, Clostridium difficile and GRE bacteraemia mandatory reports, 2007

MRSA and GRE bacteraemia and Clostridium difficile infection data have been published as part of the Department of Health's mandatory surveillance programme for healthcare-associated infection. This programme provides for quarterly publication of the MRSA bacteraemia and C. difficile infection data and annual publication of GRE bacteraemia data. For the first time, the C. difficile infection data are published by financial year as well as calendar year, as a result of enhancements to the surveillance (in order to allow monitoring of the new PSA target for C. difficile) which came into effect on 1 April 2007.

The highlights are: a continuing fall in MRSA bacteraemias and, whilst there has been a 6% increase in C. difficile infections in patients aged 65 years and over compared to the previous quarter, this marks a 32% fall on the same period in the previous year. The annual numbers and rate of C. difficile infection appear to be falling. GRE bacteraemia levels are similar to the previous year, but the number of Trusts with 10 or more of these infections is rising. Most of these are acute teaching Trusts.

MRSA bacteraemia (all ages)

•  Quarterly data for MRSA bacteraemia
Data for January to March 2008 show that there were 966 reports of MRSA bacteraemia between January and March 2008, which is an 11% decrease on the 1,088 cases recorded for the last quarter (October to December 2007).

•  Six monthly data for MRSA bacteraemia
In the six months between October 2007 and March 2008 there were 2,054 reports of MRSA bacteraemia. This represents a 14% decrease from the 2,384 reports in the previous six month period.

•  Financial year data for MRSA bacteraemia
During financial year April 2007 to March 2008, 4,438 cases of MRSA bloodstream infection were reported. This is a decrease of 30% from financial year 2006/07, when there were 6,383 reports. The rate of MRSA bacteraemia in 2007/08 was 1.16 cases per 10,000 bed-days. This compares to a rate of 1.67 cases per 10,000 bed-days reported for 2006/07.

 

C. difficile

•  Quarterly data for C. difficile infection (2-64 years of age and 65 years and over)
Data show that there were 2,353 cases recorded between January and March 2008 in patients aged between 2 and 64 years of age. This marks a 5% increase on the previous quarter (October to December 2007), when 2,237 cases were reported.

Data show that there were 10,586 cases recorded in patients aged 65 years and over during January to March 2008. This figure represents a 32% decrease when compared to the same period last year (January to March 2007), when 15,644 cases were reported.

It should be noted that numbers of C. difficile infections have historically been higher in the January to March quarter relative to previous quarters. The strong seasonality effect in previous years may in part be linked to the treatment of respiratory conditions (particularly pneumonia) by broad-spectrum antibiotics. There are two possible explanations for the observed decrease in C. difficile this year; less respiratory disease this winter than in previous years, and a possible reduction in the prescribing of these antibiotics. At this stage we are uncertain as to which was the predominant factor. However, it is part of the general trend of reduced C. difficile infections.

•  Calendar year data for C. difficile infection (65 years and over only)
50,392 cases were reported between January and December 2007. This represents a 9% decrease in cases compared to January to December 2006, when 55,635 cases were reported. The national rate of C. difficile infection in patients aged 65 years and over decreased from 2.45 cases per 1,000 bed days in 2006 to 2.25 cases per 1,000 bed days in 2007.

•  Financial year data for C. difficile infection (2 - 64 years of age and 65 years and over):
A total of 45,334 cases of C. difficile infection were reported in patients aged 65 years and over between April 2007 and March 2008. In patients aged 65 years and over a rate of 1.56 cases per 1,000 bed days was reported for the period April 2007-March 2008 (rates are based on specimens taken in an acute Trust hospital only).

A total of 10,059 cases of C. difficile infection in patients aged 2-64 years were reported for the 2007/8 financial year.

The rate of C. difficile infection in patients aged 2-64 years is 0.59 per 1,000 bed days for the period April 2007 to March 2008 (rates are based on specimens taken in an acute Trust hospital only).

Reported specimens from patients aged 2-64 years represent 18% of all reports under the mandatory scheme for C. difficile infection in patients aged 2 years and over.

GRE bacteraemia (all ages)

The latest annual (October 2006 to September 2007) reporting of glycopeptide-resistant enterococcal (GRE) bacteraemia shows that there were 910 reports during this period. This represents a marginal increase of 0.8% from the 903 cases reported between October 2005 and September 2006.

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 data will continue to be reported on an annual basis.

Further details on this publication can be found on the HPA website.

Reference
1. Quarterly reporting results for Clostridium difficile infections, MRSA Bacteraemia and GRE bacteraemia. July 2008. Health Protection Agency website [online]. London: Health Protection Agency, 17 July 2008 [accessed 18 July 2008]. Available at, http://www.hpa.org.uk/infections/topics_az/hai/Mandatory_Results.htm