Latest data shows serious infections on the rise

New data from Public Health England shows that up to March this year the number of infections for E coli, MRSA, and MSSA and C difficile all increased from the previous year with PHE warning interventions needed to be put in place across whole health economies.

The increases in infection rates come after the first year of a government campaign to halve the rate of gram negative infections by 2021. While infections have increased, PHE said the rate of growth particularly with E coli had slowed.

According to the latest annual report there were 41,060 E coli infections reported by NHS trusts in the year to March 2018, of which 7,704 were classed as “hospital-onset”. The total number of cases increased by more than one per cent on the year before, and were a 27 per cent rise since 2012. This is a smaller increase than previous years where growth averaged 5 per cent a year since 2012.

A total of 846 MRSA infections were reported by acute trusts in England between April 2017 and March this year. An increase of 2.5 per cent from 2016 to 2017.

A total of 11,938 cases of MSSA infections were reported in the year to March 2018. An increase of 3.8 per cent from 2016-17 and an increase of 36.2 per cent from 2011 to 2012.

During the 12 month period a total of 13,286 C difficile infections were reported, an increase of 3.4 per cent from 2016-17.

The PHE report said: “Rates of E coli bacteraemia continue to rise. However, this rise was proportionally smaller than seen in previous years. For the infections considered here, rates are highest among older patients (over 85 years old), and with the exception of C difficile, particularly in older men.

“A high proportion of E coli bacteraemia and MSSA bacteraemia cases were community onset thus reinforcing the need for interventions across the whole health economy to reduce the rates of these infections. The high rates of gram-negative bacteraemias and diverse nature of these infections compared to MRSA and C difficile present a significant challenge to achieving the ambition to halve healthcare associated gram-negative bacteraemia by March 2021.

“However, in this first year of the ambition, we have seen the first signs of a reduction in the established year on year increases in E coli bacteraemia since the mandatory surveillance started.”

The report added: “With many of the cases of E coli being community-onset, altering clinical practice to reduce infection rates is likely to be harder. Urinary tract infections were found to be the main source of gram-negative bacteraemia cases and thus should be targeted by infection protection control programmes if substantial reductions are to be achieved. If urinary tract infections can be reduced or where they do occur detected and resolved quickly then a concomitant reduction in bacteraemias should follow.”

PHE said there was geographical variation in rates of E coli with the highest rates in the North of England particularly Cumbria and the North East regions. The London region had the lowest rate.

On C difficile PHE said the majority of cases were not hospital-onset which it said “indicates that new interventions are required in the community setting.”

NHS Improvement, which has previously warned NHS boards to take a closer look at their efforts on infection prevention and publish annual reports, said community care needed to be a priority.

Director of nursing Ruth May said: “we are now starting to see a slowdown in the increase of these types of infections, but we must do a lot more together, to ensure we reduce them in line with the national ambitions in response to the global issue of anti-microbial resistance.”