I was recently browsing through the HCAI mandatory reporting data in England (as you do) and noticed that the increasing trend in E. coli BSIs and MSSA BSIs seems to be following a similar trajectory. Could the drivers of these two distinctly different organisms be similar?
The figure below shows the number of C. difficile infections, E. coli BSIs, MRSA BSIs, and MSSA BSIs reported in England via the mandatory reporting HCAI scheme.
Figure: Findings of the HCAI mandatory reporting scheme in England.
- It looks like MSSA BSI and coli BSI are rising at a very similar rate, in the backdrop of dramatic falls and then a plateau in C. difficile infection and MRSA BSI.
- There’s evidence of seasonality in coli BSI, but not in MSSA BSI.
- PHE don’t report on ‘Trust-attributed’ (i.e. post-48 hour) or ‘non-Trust-attributed’ for MSSA BSI and coli BSI in the publically available raw data (although they do in the annual epi summary, here – as you can see, both Trust and non-Trust attributed cases are rising).
- Could a common link driving both MSSA BSIs and coli BSIs be a reduction in antibiotic prescribing in the community (see ESPAUR report)? You’d like to think that the majority of reduced antibiotic use is inappropriately prescribed in the first place, but this will not always be the case.
- Or could this be changes in the population demographics (e.g. aging population), and more invasive procedures?
I would be interested to hear your views on why MSSA BSI and E. coli BSI seem to be rising, and whether there could be common drivers (that we can address).
2 thoughts on “What’s driving increases in MSSA BSI and E. coli BSI in England?”
Quite possibly the drivers in England are the same as the drivers in Wales. Our recent article in JHI (https://doi.org/10.1016/j.jhin.2018.04.009) shares our view that The E coli and MSSA bacteraemia, which we agree have the same trajectory, are due to the success of our sepsis programme. More blood cultures are being taken with a concomitant increase in the positives. However, the rate of positivity is not changing and it may be that we have to look for a smarter target than just counting specific organisms. We will be following the ratio of our positives to both total blood cultures and negative blood cultures. As we conclude, the current targets are simply setting the NHS up to fail. My personal view is that whipping us harder will not change reality.
Our health board has been looking at this for quite some time and have been actively taking our HCAI programme into the community with a lot of emphasis on appropriate urine sampling and UTI management. We hope to report further on this in due course.
Thanks Mike for this insightful comment – really interesting.