Trends in S. aureus bacteremia : England compared with its Celtic neighbors Rosy Reynolds, Russell Hope on behalf of the BSAC Working Party on Resistance Surveillance K-948, 51 st ICAAC, Chicago, Sept 2011

England Scotland Ireland N. Ireland Wales UK England Scotland Wales N. Ireland Ireland Population (2009): England 51.8m Neighbours 14.5m

2010 BSAC Bacteraemia Resistance Surveillance 40 laboratories (was 25 up to 2009) Target of 500 isolates of S. aureus /year from blood (was 250 up to 2007) Central testing - HPA Colindale, London. BSAC agar dilution MICs and mecA test Data on website:

ACKNOWLEDGEMENTS British Society for Antimicrobial Chemotherapy (BSAC) Bacteraemia Resistance Surveillance Programme Sponsors Collecting Laboratories Astellas AstraZeneca Cerexa / Forest Cubist J&J / Janssen Merck / MSD Novartis (Chiron) Pfizer (Wyeth) Theravance Russell Hope David Livermore and many others HPA Colindale

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OR for difference in slope = 1.21, p=0.004

Targeted interventions Mandatory reporting (2001) Care bundles Hand hygiene / infection control Mandatory admissions screening / decolonisation (2009) Deep cleaning Unintended effects / ecological pressures Shorter hospital stays? Changes in antibiotic use? ???

Other information available Sex>99% Age>99% Care setting99% (≥48 or <48 hours in hospital) Hospital speciality90% Presumed focus of infection63% ( %)

7.6% of S. aureus bacteraemias were from ICU

Summary 1 MRSA stable around 42%, % MRSA fell in ICU before 2006 (when stable in other specialities) % of reported line-related S. aureus bacteraemias fell before 2006 (but equally for MRSA and MSSA) Since 2006, widespread large reduction in MRSA bacteraemias (number and %).

Summary 2 Drop in %MRSA since 2006 was faster in England (to 14% vs. 28% by 2010) but not affected by age sex hospital-acquisition hospital speciality focus of infection Reasons are not clear.