Reductions in MRSA, Clostridium difficile and Intensive Care Unit (ICU) Acquired Bloodstream Infections and over 9 years from 276 United Kingdom ICUs

Abstract

BackgroundA major focus on preventing resistant organisms and hospital-acquired infections over the past 10 years has seen well-documented reductions in MRSA and C. difficileat hospital and national level. Less is known about national changes in epidemiology of bloodstream infections, and such data is important to frame future national priorities and targets.MethodsData from the Intensive Care National Audit and Research Centre Program on MRSA, C. difficile and VRE colonization and ICU-acquired bloodstream infections (UABSIs) from 1,195,103 consecutive patients admitted to 276 UK ICUs (excluding Scotland) from 2007 to 2015 was analyzed.ResultsMRSA and C. difficile colonizations per 1000 patients decreased significantly (MRSA admissions 38.8 to 12.03 (P = 0.00003); MRSA acquisitions 25.4 to 3.1(P = 0.0008); C. difficile admissions 10.6 to 4.1(P = 0.0001); C. difficile acquisitions 11.1 to 3.3 (p = 0.0005). Reductions predominantly occurred between 2007 and 2011 with MRSA but not C. difficile. In contrast VRE admissions and ICU-acquisitions increased from 1.9 to 5.8 (P = 0.002) and 1.5 to 5.6 (P = 0.005), respectively. There were 13,147 UABSI episodes in 11,075 (1.8%) of 621,859 patients staying >48 hours. The UABSI rate fell from 6.6 (95% CI 6.33–6.97) to 1.7 (95% CI 1.5–1.7)/1000 bed days (P < 0.0001), with the reduction taking place between 2007 and 2011 and no significant reduction since. A fixed effect model identified lower age, male sex, severity of illness, larger ICU-size, immunosuppressive therapy (but not immunosuppressive illness) as significant risk factors for UABSI. MSSA, E. coli, Enterococci, Yeast, Klebsiella sp and P. aeruginosa accounted for 73% of all recorded first UABSIs. Greatest reduction was seen for MRSA (97%), Pseudomonas aeruginosa(80%), S. aureus (77%) and Yeast (71%), with lower reductions for E. coli (54%) and Klebsiella(42%).ConclusionLarge decreases in ICU-acquired bloodstream infections occurred across UK ICUs at the same time as reductions in MRSA and C. difficile, but rates have been static since 2011. Reductions were seen for all organisms. The observation that no material reductions in UABSIs were observed during the last 5 years of the study, despite continued focus on improving infection control practice throughout, implies that benefits from the current intervention framework have been achieved.Disclosures All authors: No reported disclosures.