There was a significant decrease in the case fatality rates (CFRs) of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible S aureus (MSSA), Escherichia coli bacteraemia and Clostridium difficile infections (CDI) over the last ten years, according to a new report from Public Health England.
In 2017/18, 30-day all-cause CFRs following bacteraemia due to MRSA, MSSA, E. coli, and CDI were 27%, 20.2%, 14.8%, and 15.2%, respectively, compared to 38.9% (2007/08), 21.5% (2011/12), 16.8% (2012/13), and 26.3% (2007/08), respectively.
Enhanced mandatory surveillance of Klebsiella spp. and Pseudomonas aeruginosa bacteraemia only began in April 2017, but their CFRs in 2017/18 were 20.2% and 27%, respectively.
The report said the large reductions in the CFRs of all MRSA bacteraemia and CDI in the last decade are indicative of their changing epidemiology. Both infections have gone from predominantly hospital-onset to community-onset infections in the past ten years.
While MRSA and P. aeruginosa bacteraemia currently have the highest CFRs, the greatest number of deaths are reported following E. coli bacteraemia due to its higher incidence: In 2017/18, there were 5865 30-day all-cause deaths following E. coli bacteraemia infection compared to 219 following MRSA, 2328 following MSSA, and 1116 following P. aeruginosa bacteraemia infection.
Noting large declines in the incidence rates of MRSA bacteraemia (81%) and CDI (76%) between 2007/08 and 2017/18, the report flags the year-on-year increases in incidence rates of MSSA and E. coli bacteraemia.