Healthcare Associated Infections |
Published on: 16 December 2011 |
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Trends in mandatory MRSA bacteraemia and Clostridium difficile infection data and the first nine months of mandatory MSSA bacteraemia data for England up to July-September 2011
This ninth publication of the quarterly epidemiological commentary contains trend analyses for mandatory surveillance of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium difficile infections (CDI) reported by NHS acute Trust hospitals in England up to September 2011 [1,2]. A summary of meticillin-sensitive Staphylococcus aureus (MSSA) bacteraemia data collected to date is also provided. This is the third quarterly epidemiological commentary to include mandatory surveillance data on MSSA bacteraemia; collection of MSSA bacteraemia data became mandatory in January 2011 [3].
The complete epidemiological commentary with additional information on the rates of MRSA bacteraemia and CDI and MSSA bacteraemia data for the first three quarters of 2011 is available on the HPA website [4]. Methodological information including details of the Trust apportioning process can be found below.
The next commentary will be published in March 2012.
Note:
All references to quarterly data are based on calendar year definitions, and NOT financial year definitions (eg Q1 2009 refers to January-March 2009 and NOT to April-June 2009).
MRSA bacteraemia
- The quarterly average of MRSA bacteraemia reports for the financial year 2003/04 of 1,925 reports is used to calculate a baseline against which future data can be compared.
- In the most recent quarter (July-September 2011) there was an 86.2% decrease in reports relative to the baseline.
- There has been a 42.6% decrease in total reports (462 to 265) from July-September 2009 to July-September 2011 (figure 1).
- Compared to the previous quarter (April-June 2011) there has been a 16.7% decrease (from 318 to 265 reports).
Figure 1. Quarterly counts of Trust apportioned and all other reports of MRSA bacteraemia: July 2009 to September 2011
MSSA bacteraemia
The data included in this quarterly report represents early analysis of the first three quarters of MSSA bacteraemia surveillance (January-September 2011) collected from English NHS acute Trusts.- There were a total of 6,573 reports between January and September 2011; 2,148 of these reports were Trust apportioned and 4,425 were non-Trust apportioned.
- A summary of reports by month is presented in table 1. Details of both Trust apportioned and non-Trust apportioned MSSA bacteraemia reports are provided.
- A summary of patient demographics and admission status is presented in table 2. Reports are split into Trust apportioned and non-Trust apportioned MSSA bacteraemia reports.
Table 1. Monthly counts of Trust apportioned and all other reports of MSSA bacteraemia, January-September 2011
| January-September 2011 | |||
|---|---|---|---|
Trust Apportioned |
Non-Trust apportioned |
Total |
|
January |
239 |
506 |
745 |
February |
237 |
452 |
689 |
March |
258 |
503 |
761 |
April |
238 |
465 |
703 |
May |
236 |
526 |
762 |
June |
222 |
492 |
714 |
July |
218 |
500 |
718 |
August |
232 |
479 |
711 |
September |
268 |
502 |
770 |
Total |
2,148 |
4,425 |
6,573 |
Table 2. Summary of MSSA bacteraemia patient demographics and admission status, January-September 2011
January-September 2011 |
||||||
Trust apportioned (%) |
Non-Trust apportioned (%) |
Total (%) |
||||
| Gender | ||||||
| Females | 826 |
(40.0) |
1,602 |
(37.5) |
2,428 |
(38.3) |
| Males | 1,238 |
(60.0) |
2,680 |
(62.5) |
3,918 |
(61.7) |
| Not known/unspecified | 84 |
(–) |
143 |
(–) |
227 |
(–) |
| Age at diagnosis | ||||||
| <1 | 225 |
(10.5) |
135 |
(3.1) |
360 |
(5.5) |
| 1-14 | 56 |
(2.6) |
305 |
(6.9) |
361 |
(5.5) |
| 15-44 | 255 |
(11.9) |
792 |
(17.9) |
1,047 |
(15.9) |
| 45-54 | 225 |
(10.5) |
501 |
(11.3) |
726 |
(11.0) |
| 55-64 | 274 |
(12.8) |
664 |
(15.0) |
938 |
(14.3) |
| 65-74 | 372 |
(17.3) |
758 |
(17.1) |
1,130 |
(17.2) |
| ≥75 | 741 |
(34.5) |
1,270 |
(28.7) |
2,011 |
(30.6) |
| Admission Method | ||||||
| Emergency | 1,450 |
(78.0) |
3,645 |
(93.8) |
5,095 |
(88.7) |
| Elective | 215 |
(11.6) |
127 |
(3.3) |
342 |
(6.0) |
| Other | 195 |
(10.5) |
115 |
(3.0) |
310 |
(5.4) |
| Not known/unspecified | 288 |
(–) |
538 |
(–) |
826 |
(–) |
| Admission source | ||||||
| Home | 1,638 |
(84.3) |
3,584 |
(92.2) |
5,222 |
(88.7) |
| Nursing/residential home | 60 |
(3.1) |
194 |
(4.6) |
254 |
(4.3) |
| Other hospital | 160 |
(8.2) |
89 |
(1.8) |
249 |
(4.2) |
| Other | 84 |
(4.3) |
77 |
(1.4) |
161 |
(2.7) |
| Not known/unspecified | 206 |
(–) |
481 |
(–) |
687 |
(–) |
Clostridium difficile infection
- The quarterly average of CDI reports for the financial year 2007/08 of 13,875 reports is used as the baseline against which future data comparisons can be made.
- Data for the most recent quarter (July-September 2011) showed a total of 4,981 reports, which corresponds to a 64.1% reduction relative to the baseline.
- This is a 15.7% decrease on the same quarter in 2010 (July-September 2010) when the total number of reports was 5,909 (Figure 2).
- There has been a 44.3% decrease in total reports (8,948 to 4,981) from July-September 2008 to July-September 2011. Compared to the previous quarter (April-June 2011) there has been a minimal increase (from 4,955 to 4,981 reports).
- There has been a 56.5% decrease in Trust apportioned reports (4,687 to 2,040) from July-September 2008 to July-September 2011. Compared to the previous quarter (April-June 2011) there has been a decrease of 7.6% (2,207 to 2,040) in Trust apportioned reports.
- The number of all other reports (non-Trust apportioned reports) has decreased by 31.0% (4,261 to 2,941) from July-September 2008 to July-September 2011. Compared to the previous quarter (April-June 2011) there has been a 6.9% increase (2,750 to 2,941) in all other reports.
.
Figure 2. Quarterly counts of all CDI reports and Trust apportioned and all other reports: July 2008 to September 2011 
Notes
MRSA bacteraemia Trust apportioned episodes: The analysis of Trust apportioned and all other reports is based on the model outlined by the National Quality Board (http://www.dh.gov.uk/en/Consultations/Closedconsultations/DH_100641).
This includes patients who are (i) in-patients, day-patients, emergency assessment patients or not known; AND (ii) have had a specimen taken at an acute trust; AND (iii) specimen is 3 or more days after date of admission (admission date is considered day ‘1').
MSSA bacteraemia Trust apportioned reports: The analysis of Trust apportioned and all other reports is based on the criteria applied to MRSA bacteraemia.
CDI Trust apportioned episodes: include patients who are (i) in-patients, day-patients, emergency assessment patients; AND (ii) have had a specimen taken at an acute Trust or not known; AND (iii) specimen is 4 or more days after date of admission (admission date is considered day ‘1').
Non-Trust apportioned reports ('all other reports'): These include all reports that are NOT apportioned to an acute Trust. The two categories are mutually exclusive.
References
1. Mandatory Staphylococcus aureus bacteraemia surveillance scheme.
2. Mandatory Clostridium difficile infection surveillance scheme.
3. HPA. Healthcare-associated infections: changes to reporting for MSSA bacteraemia. Health Protection Report 2011; 5(2): news.
4. Quarterly Epidemiological Commentaries on MRSA bacteraemia and C. difficile infection in England. HPA website: Infectious Diseases › Infections A-Z › Staphylococcus aureus › Epidemiological Data Staphylococcus aureus › Mandatory Surveillance of Staphylococcus aureus bacteraemia › Quarterly Epidemiological Commentaries on MRSA and MSSA bacteraemia and C. difficile infection.