Research and analysis

HPR volume 12 issue 26: news (20 and 21 July)

Updated 21 December 2018

Mandatory HCAI bacteraemia and C. difficile infection (England, financial year April 2017 to March 2018) in summary

Public Health England’s (PHE) latest annual data and annual epidemiological commentary on trends in reports of Gram-negative bacteraemia (Escherichia coli, Klebsiella species and Pseudomonas aeruginosa), Staphylococcus aureus (MRSA and MSSA) bacteraemia and Clostridium difficile infections – in England up to and including financial year 2017 to 2018 – have been published on the GOV.UK website [1,2].

The report, including tabular and graphical information, updates the previous annual report published in July 2017. This is the first time annual data have been presented for mandatory surveillance of bacteraemia caused by Klebsiella spp. and P. aeruginosa. Some key facts are listed below.

Gram-negative bacteraemia

A total of 41,060 cases of E. coli bacteraemia were reported by NHS Trusts in England between 1 April 2017 and 31 March 2018. Of the 41,060 E. coli cases, 7,704 (18.8%) were hospital-onset. The total number of cases reported in 2017 to 2018 is an increase of 1.1% from 2016 to 2017 (n=40,630), and an increase of 27.1% from 2012 to 2013 (n=32,309). The rate of E. coli cases per 100,000 population has risen from 60.4 in 2012 to 2013 to 74.3 in 2017 to 2018.

For bacteraemia caused by Klebsiella spp., 9,617 cases of Klebsiella spp. bacteraemia were reported by NHS Trusts in England between 1 April 2017 and 31 March 2018. Of the 9,617 Klebsiella spp. cases, 2,853 (29.7%) were hospital-onset.

Fewer cases of bacteraemia were caused by P. aeruginosa (4,286 cases, of which 37.8% were hospital-onset).

Data on the source of bacteraemia indicate that urinary tract infections (UTI) are the predominant source, causing 49% of E. coli bacteraemia, 32% of Klebsiella spp. bacteraemia and 30% of P. aeruginosa bacteraemia.

MRSA and MSSA bacteraemia

A total of 846 cases of MRSA bacteraemia were reported by NHS acute trusts in England between 1 April 2017 and 31 March 2018. This is an increase of 2.5% from 2016 to 2017 (n=825), and a decrease of 81% from 2007 to 2008 (n=4,451).

A total of 11,938 cases of MSSA bacteraemia were reported by NHS acute Trusts in England between 1 April 2016 and 31 March 2018. This is an increase of 3.8% from 2016 to 2017 (n=11,499), and an increase of 36.2% from 2011 to 2012 (n=8,767).The rate of all MSSA cases per 100,000 population, per year has risen from 16.4 in 2011 to 2012 to 21.6 in 2017 to 2018.

Clostridium difficile infection

A total of 13,286 cases of Clostridium difficile infection were reported by NHS Trusts in England between 1 April 2017 and 31 March 2018. This translates to a small increase of 3.4% from 2016 to 2017 (n=12,845), and a decrease of 76.1% from 2007 to 2008 (n=55,498).

References

1. PHE (July 2018). Annual counts and rates and quarterly counts of infection and quarterly counts by acute trust or CCG and by onset status, England 2017 to 2018:

• E. coli bacteraemia
• Klebsiella spp. bacteraemia
• P. aeruginosa bacteraemia
• MRSA bacteraemia
• MSSA bacteraemia
• C. difficile infection

1. PHE (12 July 2018). Annual epidemiological commentary: Gram-negative bacteraemia, MRSA bacteraemia, MSSA bacteraemia and C. difficile infections, up to and including financial year April 2017 to March 2018. Published 12 July 2018.

Transfusion-transmitted infections (UK) 2017: in summary

Transfusion transmitted infections (TTIs) remain rare in the UK due to the selection of donors at low risk of infection and the exclusion of donations found positive on screening. During 2017, the UK Blood Services investigated 106 incidents suspected to be due to bacterial transmission and 8 incidents of suspected viral transmission. From these suspected incidents, there was:

• one confirmed transfusion-transmitted hepatitis A virus (HAV) incident, linked to the ongoing outbreak in the general population
• one confirmed transfusion-transmitted hepatitis E virus (HEV) incident transfused prior to the introduction of universal screening
• one probable transfusion-transmitted HEV incident transfused prior to the introduction of universal screening
• one possible Staphylococcus capitis bacterial transfusion transmission incident, could not be confirmed as packs had been discarded.

Further information on these incidents is provided in the Serious Hazards of Transfusion (SHOT) Annual Report 2017, Chapter 17 [1].

Three important messages emerge from the report. Firstly, transfusion-transmitted infections are rare. Secondly, the estimated risk of hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV) not being detected on screening in the UK is very low, at less than 1 in 2 million donations tested [2]; nevertheless, to maintain haemovigilance, investigations are performed if a recipient is suspected to have been infected via transfusion. Finally, bacterial screening of platelets will significantly reduce, but not eliminate, the risk of transfusion transmission of bacteria.

Following a review by the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) in October 2016, UK Blood Services implemented 100% HEV-screening. From April 2017, 100% HEV-screened red blood cells were available in Wales and Scotland; in England from 1 May 2017 and in Northern Ireland from 30 May 2017. No HEV TTIs have been reported from recipients who received screened HEV-negative platelets.

Suspected TTIs should be reported to the blood services who can advise on the information required and how to proceed. Further details on how to report are available online.

For further information on the UK TTI surveillance please contact the joint NHSBT/PHE Epidemiology Unit at epidemiology@nhsbt.nhs.uk.

References

1. PHB Bolton-Maggs (ed), D Poles et al (on behalf of the Serious Hazards of Transfusion (SHOT) Steering Group) (2018). The 2017 annual SHOT report.
2. NHS Blood and Transplant / Public Health England Epidemiology Unit (2018). The estimated residual risk that a donation made in the infectious window period is not detected on testing: risks specific for HBV, HCV and HIV in the UK, 2015 to 2017.

Infection reports in this issue

Pseudomonas and Stenotrophomonas spp bacteraemia annual report

Between 2013 and 2017, in EWNI, the rate of Pseudomonas spp. bacteraemia increased 27% while the rate of Stenotrophomonas spp. bacteraemia remained stable, according to the annual report for these 2 genera published in this issue of HPR. Resistance patterns for key antimicrobials remained broadly stable. The report is based on analysis of 2017 data extracted from PHE’s voluntary surveillance database (SGSS) as at May 2018. The report also presents analysis of data according to geographical region and age of cases.

Laboratory surveillance of Pseudomonas spp. and Stenotrophomonas spp. bacteraemia in England, Wales and Northern Ireland: 2017.

Gastrointestinal infections and foodborne outbreaks in humans, England and Wales

Routine reports of foodborne illness in humans, England and Wales: weeks 22 to 26, 2018.