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

Background: Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa are included in the mandatory surveillance of bloodstream infections (BSI) in England. Aim: We aimed to investigate the epidemiology of these BSIs in England April 2017–March 2022. Methods: We 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. Results: The 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. col i (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. Conclusions: Appropriate management of UTIs and urinary catheterisation is essential for reduction of these BSIs.