Research and analysis

HPR volume 10 issue 31: news (16 September)

Updated 16 December 2016

1. Mandatory HCAI reports quarterly trends: April to June 2016

PHE’s latest quarterly epidemiological commentary on trends in reports of Staphylococcus aureus (MRSA and MSSA) and Escherichia coli bacteraemia, and of Clostridium difficile infections, mandatorily reported by NHS acute Trusts in England up to April-June 2016, has been published on the GOV.UK website [1].

The report, including tabular and graphical information, provides data for the April-June 2016 quarter (updating the previous report published in June 2016). Some key facts are listed below.

1.1 MRSA bacteraemia

Since the January-March 2013 quarter, there has been a 19.9% decrease (1.9 to 1.5 reports per 100,000 population) in rate of total MRSA bacteraemia cases, as at April-June 2016. This is part of a general decreasing trend that began in April 2007. However, between April-June 2015 and April-June 2016 the rate of all reported MRSA bacteraemia remained stable at 1.5 cases per 100,000 population (from 209 to 207 cases). During this period (April-June 2015 to April-June 2016) the count and rate of MRSA bacteraemia assigned to a CCG increased by 14.6% and 14.9%, respectively (from 82 to 94 reported cases and from 0.6 to 0.7 cases per 100,000 population). Conversely, the counts and rates of MRSA bacteraemia assigned to a trust both decreased by 21.7% (from 83 to 65 reported cases and from 1.0 to 0.8 per 100,000 bed-days, respectively) within the same period. In addition, the counts and rates of third party-assigned MRSA bacteraemia cases increased slightly by 9.1% and 9.4% respectively between April-June 2015 and April-June 2016 (from 44 to 48 cases and from 0.3 to 0.4 cases per 100,000 population).

1.2 MSSA bacteraemia

The current quarter saw the highest rate of all reported MSSA bacteraemia (20.6 cases per 100,000 population) as well as trust-apportioned MSSA bacteraemia (9.5 cases per 100,000 bed days) since the mandatory reporting of MSSA bacteraemia cases was initiated in January 2011. This increase was also observed in the counts and rates of all reported MSSA bacteraemia when compared with the same quarter from the previous year (April-June 2015 to April-June 2016) – an increase of 9.2% and 9.5%, respectively (from 2,568 and 2,803 cases and 18.8 and 20.6 cases per 100,000 population). Similarly, within the same period, the counts and rates of trust-apportioned MSSA bacteraemia have both increased by 20.3% (from 680 to 818 cases and from 7.9 to 9.5 cases per 100,000 bed days.

1.3 E. coli bacteraemia

The counts and rates of reported E. coli bacteraemia have increased by 29.0% (from 7,602 to 9,808 cases) and 25.8% (from 57.2 to 72.0 cases per 100,000 population) overall, between January-March 2013 and the current quarter (April-June 2016), with seasonal peaks generally reported between July and September each year. Similarly between April-June 2015 and April-June 2016 there was a 7.2% increase (from 67.2 to 72.0 cases per 100,000 population) in the rate of all reported E. coli bacteraemias.

1.4 C. difficile infection (CDI)

Between April-June 2015 and April-June 2016 there was a 16.1% and 15.9% decrease (from 3,652 to 3,064 cases and from 26.7 to 22.5 cases per 100,000 population) in the counts and rates of all reported CDI respectively. Similarly, the counts and rates of trust-apportioned CDI cases both decreased by 16.4% (from 1,322 to 1,105 cases and from 15.4 to 12.8 cases per 100,000 bed-days respectively) over the same period).

1.5 Reference

1. PHE (8 September 2016). Quarterly Epidemiological Commentary: Mandatory MRSA, MSSA and E. coli bacteraemia, and C. difficile infection data (up to April-June 2016).

2. Pseudomonas infections associated with ear-piercing after-care products

Identification of cases of Pseudomonas aeruginosa infection occurring following cosmetic ear-piercing procedures – with variously-labelled after-care products being possibly implicated – has prompted Public Health England to issue a warning to members of the public who may have recently undergone any cosmetic piercing procedures [1].

Microbiologists and hospital infection control teams have also been alerted to report to their local health protection team any confirmed P. aeruginosa infections following piercing that took place on or after 1 July 2016.

As at 15 September, there was a putative link between the suspect products and 26 cases of severe P. aeruginosa infection. Two clusters of severe infection were identified among those who had undergone ear-piercing in two regions – the East Midlands and South East of England – between mid-July and late August 2016.

The suspect products, provided by piercing studios in many parts of the country, circulate in the form of a 100ml-bottled after-care saline spray which, although manufactured by Lion Care Products Ltd, bears no consistent branding or labelling.

Although swelling and soreness is expected following new piercings, a PHE press release describes symptoms of serious infection that should prompt those affected to seek medical advice [1].

Investigations are ongoing; in the meantime, microbiologists and hospital infection control teams have been requested to submit any positive P. aeruginosa isolates associated with piercing for reference typing. PHE advice for the public on aftercare following body piercings is to follow the guidelines provided on the Chartered Institute of Environmental Health website [2].

2.1 References

1. “Warning over infection that may be linked to piercing product”. PHE press release (18 September 2016).

2. CIEH website. Ear and face piercing aftercare (also Tattooing and body piercing guidance toolkit).

3. Second annual progress report on UK AMR strategy 2013-2018

The second annual progress report on implementation of the UK antimicrobial resistance strategy 2013-2018 has been published by the Department of Health on behalf of the high level steering group responsible for driving delivery of the strategy [1,2].

The report describes what was achieved during 2015, the second year of implementation, including a number of significant achievements on the international stage.

Scotland, Wales and Northern Ireland have their own AMR stategies and related delivery plans, and they report separately on implementation and surveillance. However, this report includes headline data from all four UK nations.

At the same time, the Government has published its response to the recommendations of Lord Jim O’Neill’s independent review of economic issues associated with antimicrobial resistance, published earlier this year, which made recommendations for the international community [3].

3.1 Reference

1. DH (16 September 2016). UK five-year antimicrobial resistance (AMR) strategy 2013-2018: annual progress report, 2015.
2. “Government’s progress in preventing drug resistant infections”, DH press release, 16 September 2016.
3. DH (16 September 2016). The Government’s response to Lord Jim O’Neill’s independent review on antimicrobial resistance in collaboration with the Wellcome Trust.

4. PHE annual conference proceedings

More than 50 e-posters relating to the health protection sessions at this week’s PHE annual conference held at Warwick University are available for viewing on-line (after a simple registration procedure) via the website: http://phe.multilearning.com/.

Also, many slides from the main conference health protection sessions are available (in PDF format) via the conference website (clicking through to the relevant session details, and then on the presentation title to find slides which have been made available by presenters).

Links to videos of some of the sessions will be added shortly.