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New infection threats emerging to replace MRSA and C. diff

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A third of healthcare associated infections are now caused by bacteria that need to be tackled with different infection control techniques to MRSA and C. difficile, a report has warned.

Research by the Health Protection Agency has found 32.4% of HCAIs are currently caused by Enterobacteriaceae, which are also known as coliforms, and includes Gram negative organisms such as Salmonella and E. coli.

Of these bacteria, 12.4% were found to be resistant to commonly used antibiotics – third generation cephalosporins.

Infection with these types of bacteria tend to occur when patients have devices fitted, such as IV lines and catheters, or undergo surgical procedures, as opposed to being spread from patient to patient like MRSA. As a result, they require more complex approaches to infection prevention than good hand hygiene practice.   

The HPA today published the results from its autumn 2011 HCAI prevalence survey, which reveals a snapshot of infection levels across hospital trusts in England. More than 52,000 patients were surveyed at 103 organisations.

There have been three previous HCAI prevalence surveys, the last of which was in 2006.

This year, for the first time, the survey included independent sector hospitals and measured levels of antibiotic use in hospitals, as well as infection levels. Overall the HPA said the results were positive.

A total of 3,360 patients had an HCAI – equivalent to 6.4% – of whom 135 had more than one. This compares to the 2006 survey, which found 8.2% of patients had an HCAI.

Infections were most frequently detected in the respiratory tract, urinary tract and surgical sites.

HCAI prevalence in independent hospitals was lower than NHS hospitals - 2.2% compared with 6.5%. However, the HPA highlighted that the two sectors were not comparable, as the independent sector dealt mostly with elective admissions and patients usually had a shorter length of stay than the NHS.

The survey showed that since 2006, there has been an 18-fold overall reduction in MRSA bloodstream infections, from 1.3% of patients to 0.1%. In addition, there has been a five-fold reduction in C. difficile infections, from 2% to 0.4%.

Lead report author Susan Hopkins, a healthcare epidemiologist at the HPA, said: “Measures that were put in place to tackle MRSA and C. difficile infections have ensured that over the last few years rates have consistently gone down.

“In the meantime other bacteria, notably Enterobacteriaceae – also known as coliforms – have increased. It is clear that we need to find ways to control and prevent transmission of these bacteria and this is an important priority.”

The survey also revealed that antibiotics were being used by 34.7% of patients, the majority having been prescribed for infections that started in the community. The most commonly prescribed were beta-lactum antibiotics and enzyme inhibitors

The HPA noted that in 30% of cases where antibiotics were being prescribed for surgical prophylaxis, they were being given for more than one day.

Antimicrobial use was higher in the independent sector – used by 46.5% of patients – than in NHS hospitals, where 34.3% of patients used them.

The HPA suggested this variation might be caused by less antibiotics “stewardship” in the independent sector. For example, it said independent hospitals were less likely to have an antimicrobial pharmacist.

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