1e - Reducing healthcare associated Gram-negative bloodstream infections: An England Perspective

Background : Reducing the infections associated with antibiotic resistance is paramount in the campaign to maintain the effectiveness of antibiotics. Hence, an initiative as part of the 2019-2024 UK Antimicrobial Resistance National Action Plan (NAP) set out to halve the number of healthcare-associated (HA) Gram-negative bloodstream infections (GNBSI), responsible for ~80% of AMR in infections caused by priority pathogens. We review the challenges and progress in England.

Methods : Data on the 3 priority GNBSIs (Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa) meeting the HA definition are published through UKHSAs mandatory BSI surveillance reports. For earlier data (<2018/19) Hospital Episode Statistics (HES) and UKHSA’s Secondary Generation Surveillance System (SGSS) were used to generate a proxy for the HA burden.

Results : 53,756 GNBSI were reported in 2016/17, of which we estimate 23,037 (42.9%) met the HA definition. We report in 2023/24 HA GNBSI counts to be 22,687. Incidence reached their peak in 2019/20 (24,363) before sharply declining by 19.7% (n=19,568) in 2020/21 coinciding with the COVID-19 pandemic, before resuming its upward trajectory, but remained below pre-pandemic levels. The sharp declines were mostly from reductions in E. coli cases.Multiple commitments and deliverables were developed to underpin the efforts to achieve reductions in HA GNBSI.

Conclusions : There is limited evidence on achievable reductions in HA GNBSIs, with some reports suggesting ~20% possible.  We note substantial reductions in incidence, an indirect consequence of the COVID-19 pandemic. Furthermore, the disruption of the pandemic hindered efforts to implement targeted measures to support this initiative. Lessons and learnings from the last few years, including taking forward improvements achieved through deliverables and commitments will be instrumental in development of further initiatives.