Skip to main content Accessibility help
×
Home

Impact of national policies on the microbial aetiology of surgical site infections in acute NHS hospitals in England: analysis of trends between 2000 and 2013 using multi-centre prospective cohort data

  • S. ELGOHARI (a1), J. WILSON (a2), A. SAEI (a1), E. A. SHERIDAN (a1) and T. LAMAGNI (a1)...

Summary

Our study aimed to evaluate changes in the epidemiology of pathogens causing surgical site infections (SSIs) in England between 2000 and 2013 in the context of intensified national interventions to reduce healthcare-associated infections introduced since 2006. National prospective surveillance data on target surgical procedures were used for this study. Data on causative organism were available for 72% of inpatient-detected SSIs meeting the standard case definitions for superficial, deep and organ-space infections (9767/13 531) which were analysed for trends. A multivariable logistic linear mixed model with hospital random effects was fitted to evaluate trends by pathogen. Staphylococcus aureus was the predominant cause of SSI between 2000 (41%) and 2009 (24%), decreasing from 2006 onwards reaching 16% in 2013. Data for 2005–2013 showed that the odds of SSI caused by S. aureus decreased significantly by 14% per year [adjusted odds ratio (aOR) 0·86, 95% confidence interval (CI) 0·83–0·89] driven by significant decreases in methicillin-resistant S. aureus (MRSA) (aOR 0·71, 95% CI 0·68–0·75). However a small significant increase in methicillin-sensitive S. aureus was identified (aOR 1·06, 95% CI 1·02–1·10). Enterobacteriaceae were stable during 2000–2007 (12% of cases overall), increasing from 2008 (18%) onwards, being present in 25% of cases in 2013; the model supported these increasing trends during 2007–2013 (aOR 1·12, 95% CI 1·07–1·18). The decreasing trends in S. aureus SSIs from 2006 and the increases in Enterobacteriaceae SSIs from 2008 may be related to intensified national efforts targeted at reducing MRSA bacteraemia combined with changes in antibiotic use aimed at controlling C. difficile infections.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Impact of national policies on the microbial aetiology of surgical site infections in acute NHS hospitals in England: analysis of trends between 2000 and 2013 using multi-centre prospective cohort data
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Impact of national policies on the microbial aetiology of surgical site infections in acute NHS hospitals in England: analysis of trends between 2000 and 2013 using multi-centre prospective cohort data
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Impact of national policies on the microbial aetiology of surgical site infections in acute NHS hospitals in England: analysis of trends between 2000 and 2013 using multi-centre prospective cohort data
      Available formats
      ×

Copyright

Corresponding author

*Author for correspondence: Ms. S. Elgohari, Department of Healthcare Associated Infections and Antimicrobial Resistance, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK. Email: (suzanne.elgohari@phe.gov.uk)

References

Hide All
1. Health Protection Agency. English National Point Prevalence Survey on Healthcare-associated infections and Antimicrobial Use, 2011: preliminary data, May 2012 (http://webarchive.nationalarchives.gov.uk/20160210151033/https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/331871/English_National_Point_Prevalence_Survey_on_Healthcare_associated_Infections_and_Antimicrobial_Use_2011.pdf).
2. Plowman, R, et al. The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialties of a district general hospital in England and the national burden imposed. Journal of Hospital Infection 2001; 47: 198209.
3. Coello, R, et al. Adverse impact of surgical site infections in English hospitals. Journal of Hospital Infection 2005; 60: 93103.
4. Health Protection Agency. Surveillance of surgical site infection in NHS hospitals in England 2011/12, December 2012 (http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317137334452).
5. Johnson, AP, et al. Mandatory surveillance of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in England: the first 10 years. Journal of Antimicrobial Chemotherapy 2012; 67: 802809.
6. Wilson, J, et al. Trends among pathogens reported as causing bacteraemia in England, 2004–2008. Clinical Microbiology and Infection 2011; 17: 451458.
7. Duerden, B, et al. The Control of methicillin-resistant Staphylococcus aureus blood stream infections in England. Open Forum Infectious Diseases 2015; 2: ofv035.
8. Coia, JE, et al. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. Journal of Hospital Infection 2006; 63 (Suppl. 1): S144.
9. Stone, SP, et al. Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study. British Medical Journal 2012; 344: e3005.
10. HM Treasury. PSA Delivery agreement 19: ensure better care for all. October 2007.
11. Department of Health. Saving Lives: reducing infection, delivering clean and safe care. Antimicrobial prescribing – a summary of best practice, August 2007 (http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_078117.pdf).
12. Public Health England. Annual epidemiological commentary. Mandatory MRSA, MSSA and E. coli bacteraemia and C. difficile infection data to 2015/16. July 2016 (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/535635/AEC_final.pdf).
13. Wilcox, MH, et al. Changing epidemiology of Clostridium difficile infection following the introduction of a national ribotyping-based surveillance scheme in England. Clinical Infectious Diseases 2012; 55: 10561063.
14. Chief Medical Officer. Surveillance of Healthcare Associated Infections PL/CMO/ 2003, Depatrment of Health, June 2003 (http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4013410.pdf).
15. Public Health England. Protocol for the surveillance of surgical site infection. Version 6, June 2013 (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/364412/Protocol_for_surveillance_of_surgical_site_infection_June_2013.pdf).
16. Department of Health. Screening for meticillin-resistant Staphylococcus aureus (MRSA) colonisation. A strategy for NHS Trusts: a summary of best practice, November 2006 (http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_063187.pdf).
18. Fuller, C, et al. The national one week prevalence audit of universal meticillin-resistant Staphylococcus aureus (MRSA) admission screening 2012. PLoS ONE 2013; 8: e74219.
19. Monnet, DL, Frimodt-Moller, N. Antimicrobial-drug use and methicillin-resistant Staphylococcus aureus . Emerging Infectious Diseases 2001; 7: 161163.
20. Monnet, DL, et al. Antimicrobial drug use and methicillin-resistant Staphylococcus aureus, Aberdeen, 1996–2000. Emerging Infectious Diseases 2004; 10: 14321441.
21. MacKenzie, FM, et al. Antimicrobial drug use and infection control practices associated with the prevalence of methicillin-resistant Staphylococcus aureus in European hospitals. Clinical Microbiology and Infection 2007; 13: 269269.
22. Tacconelli, E, et al. Does antibiotic exposure increase the risk methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis. Journal of Antimicrobial Chemotherapy 2008; 61: 2626.
23. Stone, SP, et al. The effect of an enhanced infection-control policy on the incidence of Clostridium difficile infection and methicillin-resistant Staphyloccocus aureus colonization in acute elderly medical patients. Age and Ageing 1998; 27: 561568.
24. Nicastri, E, et al. Decrease of methicillin resistant Staphylococcus aureus prevalence after introduction of a surgical antibiotic prophylaxis protocol in an Italian hospital. New Microbiologica 2008; 31: 519525.
25. Ellington, MJ, et al. Decline of EMRSA-16 amongst methicillin-resistant Staphylococcus aureus causing bacteraemias in the UK between 2001 and 2007. Journal of Antimicrobial Chemotherapy 2010; 65: 446448.
26. Cremniter, J, et al. Decreased susceptibility to teicoplanin and vancomycin in coagulase-negative staphylococci isolated from orthopedic-device-associated infections. Journal of Clinical Microbiology 2010; 48: 14281431.
27. Hope, R, et al. Non-susceptibility trends among staphylococci from bacteraemias in the UK and Ireland, 2001–06. Journal of Antimicrobial Chemotherapy 2008; 62 (Suppl. 2): ii65ii74.
28. Hickson, CJ, et al. Prophylactic antibiotics in elective hip and knee arthroplasty: an analysis of organisms reported to cause infections and National survey of clinical practice. Bone and Joint Research 2015; 4: 181189.
29. Horner, C, Mawer, D, Wilcox, M. Reduced susceptibility to chlorhexidine in staphylococci: is it increasing and does it matter? Journal of Antimicrobial Chemotherapy 2012; 67: 25472559.
30. Ashiru-Oredope, D, et al. Improving the quality of antibiotic prescribing in the NHS by developing a new antimicrobial stewardship programme: Start Smart – Then Focus. Journal of Antimicrobial Chemotherapy 2012; 67 (Suppl. 1): i51i63.
31. Public Health England. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) 2010 to 2014: Report 2015, November 2015 (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/477962/ESPAUR_Report_2015.pdf).
32. Brunner, M, et al. Surgery and intensive care procedures affect the target site distribution of piperacillin. Critical Care Medicine 2000; 28: 17541759.
33. Markantonis, SL, et al. Effects of blood loss and fluid volume replacement on serum and tissue gentamicin concentrations during colorectal surgery. Clinical Therapeutics 2004; 26: 271281.
34. Velissaris, D, et al. Pharmacokinetic changes and dosing modification of aminoglycosides in critically ill obese patients: a literature review. Journal of Clinical Medicine Research 2014; 6: 227233.
35. Livermore, DM, et al. Non-susceptibility trends among Enterobacteriaceae from bacteraemias in the UK and Ireland, 2001–06. Journal of Antimicrobial Chemotherapy 2008; 62 (Suppl. 2): ii41ii54.
36. Pitout, JD, Laupland, KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infectious Diseases 2008; 8: 159166.
37. Nordmann, P, Naas, T, Poirel, L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerging Infectious Diseases 2011; 17: 17911798.
38. Worth, LJ, et al. Diminishing surgical site infections in Australia: time trends in infection rates, pathogens and antimicrobial resistance using a comprehensive Victorian surveillance program, 2002–2013. Infection Control & Hospital Epidemiology 2015; 36: 409416.
39. Hidron, AI, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infection Control & Hospital Epidemiology 2008; 29: 9961011.
40. Sievert, DM, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infection Control & Hospital Epidemiology 2013; 34: 114.
41. Kallen, AJ, et al. Health care-associated invasive MRSA infections, 2005–2008. Journal of the American Medical Association 2010; 304: 641648.
42. Lessa, FC, et al. Burden of Clostridium difficile infection in the United States. New England Journal of Medicine 2015; 372: 825834.
43. Magill, S, et al. Point prevalence survey of antimicrobial use in U.S. acute care hospitals. ID Week 2012, October 2012; San Diego, USA.
44. Evans, SR, et al. Desirability of outcome ranking (DOOR) and response adjusted for days of antibiotic risk (RADAR). Clinical Infectious Diseases 2015; 61: 800806.

Keywords

Impact of national policies on the microbial aetiology of surgical site infections in acute NHS hospitals in England: analysis of trends between 2000 and 2013 using multi-centre prospective cohort data

  • S. ELGOHARI (a1), J. WILSON (a2), A. SAEI (a1), E. A. SHERIDAN (a1) and T. LAMAGNI (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed