Advertisement

Trends in rates of incidence, fatality and antimicrobial resistance among isolates of Pseudomonas spp. causing bloodstream infections in England between 2009 and 2018: results from a national voluntary surveillance scheme

  • Author Footnotes
    † These authors contributed equally to this article and share first authorship.
    S.M. Gerver
    Footnotes
    † These authors contributed equally to this article and share first authorship.
    Affiliations
    Healthcare Associated Infections and Antimicrobial Resistance Division, UK Health Security Agency, London, UK
    Search for articles by this author
  • Author Footnotes
    † These authors contributed equally to this article and share first authorship.
    O. Nsonwu
    Correspondence
    Corresponding author. Address: Healthcare Associated Infections and Antimicrobial Resistance Division, UK Health Security Agency, London, UK. Tel.: +44 208 3277 360.
    Footnotes
    † These authors contributed equally to this article and share first authorship.
    Affiliations
    Healthcare Associated Infections and Antimicrobial Resistance Division, UK Health Security Agency, London, UK
    Search for articles by this author
  • S. Thelwall
    Affiliations
    Healthcare Associated Infections and Antimicrobial Resistance Division, UK Health Security Agency, London, UK
    Search for articles by this author
  • C.S. Brown
    Affiliations
    Healthcare Associated Infections and Antimicrobial Resistance Division, UK Health Security Agency, London, UK
    Search for articles by this author
  • R. Hope
    Affiliations
    Healthcare Associated Infections and Antimicrobial Resistance Division, UK Health Security Agency, London, UK
    Search for articles by this author
  • Author Footnotes
    † These authors contributed equally to this article and share first authorship.
Published:November 19, 2021DOI:https://doi.org/10.1016/j.jhin.2021.11.013

      Summary

      Background

      This article provides baseline epidemiological data on Pseudomonas spp. bloodstream infection (BSI) in England for comparison against future findings from the mandatory surveillance of this infection, beginning April 2017.

      Aim

      To report trends in incidence, 30-day all-cause mortality and antimicrobial resistance of Pseudomonas spp. BSI in England between 2009 and 2018.

      Methods

      Patients and antibiotic susceptibility data were obtained from UK Health Security Agency's voluntary surveillance database. Mortality information was linked from a central data repository.

      Findings

      There were 39,322 Pseudomonas spp. BSIs between 2009 and 2018. Regression analysis found that the incidence rate was greater by 18.5% (P<0.01) in the summer (June–August) and by 16.2% (P<0.01) in the autumn (September–November), compared with spring (March–May). The 30-day all-cause case fatality rate (CFR) declined from 32.0% in 2009 to 23.8% in 2018 (P<0.001). In 2018, resistance to the key antibiotic agents were: ciprofloxacin (7.5%), ceftazidime (6.8%), piperacillin/tazobactam (6.6%), carbapenems (5.5%) and gentamicin (4.1%). The mortality rate per 100,000 population was greater by 25.7% (P<0.01) in autumn and 23.6% (P<0.01) in winter (December–February).

      Conclusion

      Despite an overall increase in the number of cases in recent years, the percentage of patients dying (from all causes) after a Pseudomonas spp. BSI has been declining. However, compared with other prominent healthcare-associated BSIs, the CFRs are high, and it underscores the need for continued surveillance to support targeted infection control and prevention strategies, provide further understanding of patients' risks groups, and perhaps inform antimicrobial practices.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hospital Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Appaneal H.J.
        • Caffrey A.R.
        • Jiang L.
        • Dosa D.
        • Mermel L.A.
        • LaPlante K.L.
        Antibiotic resistance rates for Pseudomonas aeruginosa clinical respiratory and bloodstream isolates among the Veterans Affairs Healthcare System from 2009 to 2013.
        Diagn Microbiol Infect Dis. 2018; 90: 311-315
        • Decraene V.
        • Ghebrehewet S.
        • Dardamissis E.
        • Huyton R.
        • Mortimer K.
        • Wilkinson D.
        • et al.
        An outbreak of multidrug-resistant Pseudomonas aeruginosa in a burns service in the North of England: challenges of infection prevention and control in a complex setting.
        J Hosp Infect. 2018; 100: e239-e245
        • Cabot G.
        • Zamorano L.
        • Moyà B.
        • Juan C.
        • Navas A.
        • Blázquez J.
        • et al.
        Evolution of Pseudomonas aeruginosa antimicrobial resistance and fitness under low and high mutation rates.
        Antimicrob Agents Chemother. 2016; 60: 1767-1778
        • Dantas R.C.
        • Ferreira M.L.
        • Gontijo-Filho P.P.
        • Ribas R.M.
        Pseudomonas aeruginosa bacteraemia: independent risk factors for mortality and impact of resistance on outcome.
        J Med Microbiol. 2014; 63: 1679-1687
        • Public Health England
        Laboratory Surveillance of Polymicrobial Bacteraemia and Fungaemia in England.
        Wales and Northern Ireland. 2017; 12: 2018
        • Department of Health and Social Care
        Tackling antimicrobial resistance 2019 to 2024: the UK’s 5-year national action plan.
        Department of Health and Social Care, 2019
        • Livermore D.M.
        • Hope R.
        • Brick G.
        • Lillie M.
        • Reynolds R.
        Non-susceptibility trends among Pseudomonas aeruginosa and other non-fermentative Gram-negative bacteria from bacteraemias in the UK and Ireland, 2001-06.
        J Antimicrob Chemother. 2008; 62: ii55-63
        • Enoch D.A.
        • Kuzhively J.
        • Sismey A.
        • Grynik A.
        • Karas J.A.
        Pseudomonas aeruginosa bacteraemia in two UK district hospitals.
        Infect Dis Rep. 2013; 5: 4
        • Evans H.
        • Bolt H.
        • Heinsbroek E.
        • Lloyd B.
        • English P.
        • Latif S.
        • et al.
        National outbreak of Pseudomonas aeruginosa associated with an aftercare solution following piercings, July to September 2016, England.
        Eurosurveillance. 2018; 23: 1700795
        • Kadambari S.
        • Botgros A.
        • Clarke P.
        • Vergnano S.
        • Anthony M.
        • Chang J.
        • et al.
        Characterizing the burden of invasive Pseudomonas infection on neonatal units in the UK between 2005 and 2011.
        J Hosp Infect. 2014; 88: 109-112
        • Guy R.
        • Geoghegan L.
        • Heginbothom M.
        • Howe R.
        • Muller-Pebody B.
        • Reilly J.S.
        • et al.
        Non-susceptibility of Escherichia coli, Klebsiella spp., Pseudomonas spp., Streptococcus pneumoniae and Staphylococcus aureus in the UK: temporal trends in England, Northern Ireland, Scotland and Wales.
        J Antimicrob Chemother. 2016; 71: 1564-1569
        • Wilson J.
        • Elgohari S.
        • Livermore D.M.
        • Cookson B.
        • Johnson A.
        • Lamagni T.
        • et al.
        Trends among pathogens reported as causing bacteraemia in England, 2004-2008.
        Clin Microbiol Infect. 2011; 17: 451-458
        • Bhaskaran K.
        • Gasparrini A.
        • Hajat S.
        • Smeeth L.
        • Armstrong B.
        Time series regression studies in environmental epidemiology.
        Int J Epidemiol. 2013; 42: 1187-1195
        • Met Office
        When does spring start?.
        (Available at:) ([last accessed September 2021])
        • R Core Team. R
        A language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Austria2020
        • Eber M.R.
        • Shardell M.
        • Schweizer M.L.
        • Laxminarayan R.
        • Perencevich E.N.
        Seasonal and temperature-associated increases in gram-negative bacterial bloodstream infections among hospitalized patients.
        PLoS One. 2011; 6: 5-10
        • Richet H.
        Seasonality in Gram-negative and healthcare-associated infections.
        Clin Microbiol Infect. 2012; 18: 934-940
        • Rosello A.
        • Pouwels K.B.
        • Domenech De Cellès M.
        • Van Kleef E.
        • Hayward A.C.
        • Hopkins S.
        • et al.
        Seasonality of urinary tract infections in the United Kingdom in different age groups: longitudinal analysis of The Health Improvement Network (THIN).
        Epidemiol Infect. 2018; 146: 37-45
        • Chudasama D.
        • Thelwall S.
        • Nsonwu O.
        • Rooney G.
        • Wasti S.
        • Hope R.
        Annual epidemiological commentary: gram-negative bacteraemia, MRSA bacteraemia, MSSA bacteraemia and C. difficile infections, up to and including financial year April 2018 to March 2019.
        Public Health England, 2019
        • Ahmed H.
        • Farewell D.
        • Jones H.M.
        • Francis N.A.
        • Paranjothy S.
        • Butler C.C.
        Incidence and antibiotic prescribing for clinically diagnosed urinary tract infection in older adults in UK primary care, 2004-2014.
        PLoS One. 2018; 13e0190521
        • Public Health England (PHE)
        30-Day all-cause fatality subsequent to MRSA, MSSA and gram-negative bacteraemia and C. difficile infections, 2017/18.
        Public Health England, London2018
        • Brown D.F.J.
        • Wootton M.
        • Howe R.A.
        Antimicrobial susceptibility testing breakpoints and methods from BSAC to EUCAST.
        J Antimicrob Chemother. 2016; 71: 3-5
        • Andrews J.M.
        BSAC standardized disc susceptibility testing method (version 7).
        J Antimicrob Chemother. 2008; 62: 256-278
        • European Committee on Antimicrobial Susceptibility Testing (EUCAST)
        Clinical breakpoints – bacteria, version 2.0.
        EUCAST, 2002
        • Matuschek E.
        • Åhman J.
        • Webster C.
        • Kahlmeter G.
        Antimicrobial susceptibility testing of colistin – evaluation of seven commercial MIC products against standard broth microdilution for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp.
        Clin Microbiol Infect. 2018; 24: 865-870
        • Public Health England (PHE)
        English surveillance programme for antimicrobial utilisation and resistance (ESPAUR).
        PHE, 2018
        • Dingle K.E.
        • Didelot X.
        • Quan T.P.
        • Eyre D.W.
        • Stoesser N.
        • Golubchik T.
        • et al.
        Effects of control interventions on Clostridium difficile infection in England: an observational study.
        Lancet Infect Dis. 2017; 17: 411-421