Incidence, case-fatality rates and risk factors of bloodstream infections caused by Escherichia coli, Klebsiella species and Pseudomonas aeruginosa, England, April 2017 to March 2022.

Abstract

BackgroundEscherichia coli, Klebsiella spp. and Pseudomonas aeruginosa are included in the mandatory surveillance of bloodstream infections (BSI) in England.AimWe aimed to investigate the epidemiology of these BSIs in England April 2017-March 2022.MethodsWe extracted data on E. coli, Klebsiella spp. and P. aeruginosa BSI, categorised BSIs as healthcare-associated (HA) or community-associated (CA) and linked to antimicrobial susceptibility and mortality data. We used multivariable logistic regression models to assess predictors of mortality.ResultsThe incidence rate of E. coli BSI was 71.8 per 100,000 population (95% confidence interval (CI): 71.5-72.1), Klebsiella spp. 19.1 (95% CI: 18.9-19.3) and P. aeruginosa 7.6 (95% CI: 7.5-7.7). Most (65,467/104,957) BSI episodes were CA. Case-fatality rate was 14.8% (95% CI: 14.6-14.9) in E. coli, 20.0% (95% CI: 19.6-20.3) in Klebsiella spp. and 25.8% (95% CI: 25.2-26.4) in P. aeruginosa BSI. Urinary tract infection (UTI) was the most reported primary infection for E. coli (56,961/100,834), Klebsiella spp. (9,098/22,827) and P. aeruginosa (3,204/8,484) BSI. Insertion or manipulation of urinary catheters was reported for 26.4% (16,136/61,043) of E. coli, 41.6% (4,470 /10,734) of Klebsiella spp. and 49.0% (2,127/4,341) of P. aeruginosa BSI. The adjusted odds ratio (OR) of death among hospital-onset HA-BSI compared to CA-BSI was 2.0 (95% CI: 1.9-2.2) for E. coli, 2.1 (95% CI: 2.0-2.3) for Klebsiella spp. and 1.7 (95% CI: 1.5-2.0) for P. aeruginosa.ConclusionsAppropriate management of UTIs and urinary catheterisation is essential for reduction of these BSIs.