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BMJ. 2007 July 28; 335(7612): 177.
PMCID: PMC1934463

C difficile cases rising, but MRSA rates falling

The number of cases of methicillin resistant Staphylococcus aureus (MRSA) infections of the blood reported to the UK Health Protection Agency fell in January to March 2007, compared with the previous quarter, figures published on Tuesday have shown. But the figures for Clostridium difficile for patients aged more than 65 years were 22% higher than in the previous quarter, October to December 2006.

There were 1444 cases of MRSA infections of the blood reported in England in January to March, compared with 1542 in the previous quarter. For the entire year, April 2006 to March 2007, 6378 cases were reported, compared with 7096 in the same period the previous year.

The biggest falls in MRSA infections were in London and in acute teaching trusts, says the agency.

“Certain hospitals have made great strides in bringing down their levels of MRSA bloodstream infection,” said Georgia Duckworth, head of the agency's healthcare associated infection and antimicrobial resistance department.

She said that they had targeted interventions at risky areas and procedures, such as indwelling devices.

“As a result they have managed to achieve significant reductions in the number of infections.”

The agency says that elderly people are the most likely group of patients to be infected with C difficile, with more than 77% of cases in patients of at least 60 years old.

“This group may be particularly at risk from MRSA bloodstream infections since many of them experience both prolonged hospital stays and admission to specialist units,” said Dr Duckworth.

The latest figures for C difficile show that 15 592 cases in patients aged at least 65 years in England were reported in the first quarter of 2007. This is 22% higher than in the previous quarter, from October to December 2006, when 12 797 cases were reported. The agency suggested that this might be because higher numbers of vulnerable people were admitted to hospital at this time of year.

Christine McCartney, who leads the agency's programme for healthcare associated infections, said that the continuing fall in the number of cases of MRSA was encouraging.

“However, there is still a lot of work to be done if we are to continue to achieve reductions in both MRSA bloodstream infections and C difficile,” she said. “Many of these infections are preventable if hygiene and antibiotic prescribing guidelines are strictly followed by trusts.”

The Liberal Democrats' shadow health secretary, Norman Lamb, said that disciplinary action may be required to ensure that standards are met and lives saved.

“An urgent investigation into the connection between high levels of antibiotic use and rates of hospital acquired infections is needed, as well as a protocol for using pioneering methods to control superbugs,” he said.

Notes

Reports of Clostridium difficile infection for individual trusts are available at www.hpa.org.uk/infections/topics_az/hai/Mandatory_Results.htm.


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