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

Background<i>Escherichia coli</i>, <i>Klebsiella</i> spp. and <i>Pseudomonas aeruginosa</i> 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 <i>E. coli</i>, <i>Klebsiella</i> spp. and <i>P. aeruginosa</i> 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 <i>E. coli</i> BSI was 71.8 per 100,000 population (95% confidence interval (CI): 71.5-72.1), <i>Klebsiella</i> spp. 19.1 (95% CI: 18.9-19.3) and <i>P. aeruginosa</i> 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 <i>E. coli</i>, 20.0% (95% CI: 19.6-20.3) in <i>Klebsiella</i> spp. and 25.8% (95% CI: 25.2-26.4) in <i>P. aeruginosa</i> BSI. Urinary tract infection (UTI) was the most reported primary infection for <i>E. coli</i> (56,961/100,834), <i>Klebsiella</i> spp. (9,098/22,827) and <i>P. aeruginosa</i> (3,204/8,484) BSI. Insertion or manipulation of urinary catheters was reported for 26.4% (16,136/61,043) of <i>E. coli</i>, 41.6% (4,470 /10,734) of <i>Klebsiella</i> spp. and 49.0% (2,127/4,341) of <i>P. aeruginosa</i> 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 <i>E. coli</i>, 2.1 (95% CI: 2.0-2.3) for <i>Klebsiella</i> spp. and 1.7 (95% CI: 1.5-2.0) for <i>P. aeruginosa</i>.ConclusionsAppropriate management of UTIs and urinary catheterisation is essential for reduction of these BSIs.