2471. Review of Methicillin-Resistant Staphylococcus aureus, Clostridium difficile and Acquired Bloodstream Infections Across all United Kingdom Intensive Care Units following Implementation of a Statutory National Infection Control Campaign.

Abstract

BackgroundMethicillin-Resistant Staphylococcus aureus (MRSA) and C. difficile infection have reduced across the UK National Health Service in the last decade following implementation of an infection control campaign. The national impact on hospital-acquired infections in the ICU however has not been comprehensively documented.MethodsData on MRSA, C. difficile, vancomycin-resistant Enterococcus (VRE) and ICU-acquired bloodstream infection (UABSIs) were analyzed from 1,189,142 consecutive patients from 2007 to 2016 recorded prospectively and standardized by highly trained assessors. Initial coverage was 139 ICUs increasing to 275 ICUs representing 100% of general, adult UK ICUs.ResultsICU MRSA and C. difficile admissions and acquisitions per 1000 patients decreased between 2007 and 2012 (MRSA admissions 38.8 to 13.1; acquisitions 25.4 to 4.1; C. difficile admissions 10.6 to 4.2; acquisitions 11.1 to 3.5), whereas VRE admissions and acquisitions increased from 1.9 to 5.3 and 1.5 to 5.9, respectively. There were 13,114 UABSIs in 1.8% patients staying >48 hours. UABSIs fell from 7.3 (95% CI 6.9–7.6) to 1.6 (95% CI 1.5–1.7)/1,000 bed-days between 2007 and 2012. Adjusting for patient admission and ICU factors the IRR was 0.21 (95% CI 0.19–0.23, P < 0.001) from 2007 to 2016. Reductions in UABSIs were seen for all main organisms excluding VRE with greatest reductions for MRSA (97%), Pseudomonas aeruginosa (80%), S. aureus (77%) and Candida spp. (71%) but lower reductions for E. coli (54%) and Klebsiella (42%).ConclusionLarge decreases in ICU-acquired infections occurred across the UK ICU network between 2007 and 2012 linked with the first few years of the national infection control campaign, but rates have been static since. Further reductions in ICU will likely require a new intervention framework.Disclosures All authors: No reported disclosures.