1d - Trends in critical care unit associated Gram-negative bloodstream infections and associated antibiotic resistance in England between 2017 and 2023: a data linkage study
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Background : Rates of hospital-onset (HO) Gram-negative bloodstream infections (GNBSIs) in England reached their highest point in 2020/21, coinciding with the beginning of the COVID-19 pandemic. GNBSIs pose a large antimicrobial resistance (AMR) threat. There is limited national data on critical care unit (CCU)-associated GNBSI incidence and related AMR.
Methods : Reports of HO Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa bacteraemia between 2017-2023 were extracted from UKHSA’s mandatory bacteraemia surveillance system and linked to the Second-Generation Surveillance System to obtain AMR results, and to Hospital Episode Statistics to determine whether cases were CCU-associated. We estimated the incidence of CCU-BSIs over time and compared AMR in CCU-BSIs vs. other hospital-onset BSIs (HO-BSIs).
Results : Of 70,867 HO GNBSIs identified during the surveillance period, 5,616 (7.9%) were determined to be CCU-BSIs. Incidence of E. coli, Klebsiella spp., and P. aeruginosa CCU-BSIs per 10,000 bed-days increased from average pre-pandemic rates of 3.4, 2.8, and 1.3, respectively, to 3.5, 6.3, and 2.6 in 2020/21, before decreasing to 2.5, 3.4, and 1.5 in 2022/23.AMR in CCUs increased in 2022/23 following reduced resistance in 2020-2022. For P. aeruginosa, across the surveillance period, CCU-BSIs exhibited higher resistance than HO-BSIs to carbapenems (19% resistant in CCU-BSI vs. 11% in HO-BSI), ceftazidime (15% vs. 9%), and piperacillin/tazobactam (17% vs. 10%). Elevated AMR in CCUs was also seen for E. coli to piperacillin/tazobactam (18% vs. 14%).
Conclusions The COVID-19 pandemic saw increased rates of Klebsiella spp. and P. aeruginosa CCU-BSIs, which have since reduced towards pre-pandemic levels. Resistance to several antibiotics in CCU-BSIs is higher than in other hospital settings, particularly for P. aeruginosa. These findings underscore the importance of antimicrobial stewardship in CCUs.