{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:26:28Z","timestamp":1790022388780,"version":"4.0.1"},"reference-count":30,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Background: Patients in critical care units (CCUs) are at an increased risk of bloodstream infections (BSIs), which can be associated with central vascular catheters (CVCs). This study describes BSIs, CVC-BSIs, organism distribution, percentage of antimicrobial resistant (AMR) organisms, and case fatality rates (CFRs) over the first six years of a voluntary national CCU surveillance programme in England. Methods: Surveillance data on BSIs, CVCs, and bed-days between 04\/2017 and 03\/2023 for adult CCUs were linked to mortality and AMR data, and crude rates were calculated. Results: The rates of CCU-BSIs and CCU-CVC-BSIs were stable for the first three years (3.6 and 1.7 per 1000 bed-days in 2019\/20), before increasing by 75% and 94% in 2020\/21, respectively, and returning to near pre-pandemic levels by 2022\/23. Gram-negative bacteria accounted for 50.3% of all CCU-BSIs, followed by Gram-positive bacteria (39.6%) and Candida spp. (8.6%). Klebsiella spp. saw increases in percentage AMR, whereas other organisms saw declines or similar levels. The overall CFR was 30.2%. Conclusions: BSI incidence in CCUs remained stable across the study period, except for an increase in 2020\/21 which reverted by 2022\/23. These data provide a benchmark for CCUs and give insight into long-term AMR patterns where comparable national data are limited.<\/jats:p>","DOI":"10.3390\/microorganisms13010183","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T10:44:23Z","timestamp":1737024263000},"page":"183","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Bloodstream Infections in Critical Care Units in England, April 2017 to March 2023: Results from the First Six Years of a National Surveillance Programme"],"prefix":"10.3390","volume":"13","author":[{"given":"Olivia D.","family":"Conroy","sequence":"first","affiliation":[{"name":"City of Wolverhampton Council, Wolverhampton WV1 1SH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1560-7465","authenticated-orcid":false,"given":"Andrea","family":"Mazzella","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London E14 4PU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9391-9697","authenticated-orcid":false,"given":"Hannah","family":"Choi","sequence":"additional","affiliation":[{"name":"Tower Hamlets London Borough Council, London E1 1BJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn","family":"Elmes","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London E14 4PU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4815-7699","authenticated-orcid":false,"given":"Matt","family":"Wilson","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London E14 4PU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimple Y.","family":"Chudasama","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London E14 4PU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M.","family":"Gerver","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London E14 4PU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miroslava","family":"Mihalkova","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London E14 4PU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Rhodes","sequence":"additional","affiliation":[{"name":"St. George\u2019s Hospital, London SW17 0QT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6865-3994","authenticated-orcid":false,"given":"A. Peter R.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University College London Hospitals, London NW1 2BU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6657-300X","authenticated-orcid":false,"given":"Nicholas","family":"Brown","sequence":"additional","affiliation":[{"name":"Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmin","family":"Islam","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London E14 4PU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell","family":"Hope","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London E14 4PU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jhin.2020.05.010","article-title":"Surveillance of bloodstream infections in intensive care units in England, May 2016\u2013April 2017: Epidemiology and ecology","volume":"106","author":"Gerver","year":"2020","journal-title":"J. Hosp. Infect."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Ko, H.-K., Yu, W.-K., Lien, T.-C., Wang, J.-H., Slutsky, A.S., Zhang, H., and Kou, Y.R. (2013). Intensive Care Unit-Acquired Bacteremia in Mechanically Ventilated Patients: Clinical Features and Outcomes. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0083298"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1186\/s13054-018-2148-0","article-title":"Epidemiology of subsequent bloodstream infections in the ICU","volume":"22","author":"Buetti","year":"2018","journal-title":"Crit. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jhin.2023.07.015","article-title":"Intermittent point prevalence surveys on healthcare-associated infections, 2011 and 2016, in England: What are the surveillance and intervention priorities?","volume":"140","author":"Henderson","year":"2023","journal-title":"J. Hosp. Infect."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2725","DOI":"10.1056\/NEJMoa061115","article-title":"An intervention to decrease catheter-related bloodstream infections in the ICU","volume":"355","author":"Pronovost","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1001\/jamainternmed.2013.9763","article-title":"Health Care\u2013Associated Infections: A Meta-analysis of Costs and Financial Impact on the US Health Care System","volume":"173","author":"Zimlichman","year":"2013","journal-title":"JAMA Intern. Med."},{"key":"ref_7","unstructured":"Centers for Disease Control and Prevention (2011). Vital signs: Central line-associated blood stream infections--United States, 2001, 2008, and 2009. MMWR Morb. Mortal. Wkly. Rep., 60, 243\u2013248."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1136\/bmjqs-2012-001325","article-title":"\u2019Matching Michigan\u2019: A 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England","volume":"22","author":"Bion","year":"2013","journal-title":"BMJ Qual. Saf."},{"key":"ref_9","unstructured":"Public Health England (2024, November 05). Surveillance of Blood Stream Infections in Patients Attending ICUs in England. Available online: https:\/\/icudcs.phe.org.uk\/ContentManagement\/LinksAndAnnouncements\/Protocol%20v3.4_07082018.pdf."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e075613","DOI":"10.1136\/bmj-2023-075613","article-title":"NHS hospital capacity during covid-19: Overstretched staff, space, systems, and stuff","volume":"385","author":"Fong","year":"2024","journal-title":"BMJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.jgar.2020.10.004","article-title":"Incidence of bacterial and fungal bloodstream infections in COVID-19 patients in intensive care: An alarming \u201ccollateral effect\u201d","volume":"23","author":"Cataldo","year":"2020","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1186\/s13054-021-03814-z","article-title":"The effect of the COVID-19 pandemic on the epidemiology of positive blood cultures in Swiss intensive care units: A nationwide surveillance study","volume":"25","author":"Damonti","year":"2021","journal-title":"Crit. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1007\/s00134-021-06346-w","article-title":"COVID-19 increased the risk of ICU-acquired bloodstream infections: A case-cohort study from the multicentric OUTCOMEREA network","volume":"47","author":"Buetti","year":"2021","journal-title":"Intensive Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Deliberato, R.O., Marra, A.R., Corr\u00eaa, T.D., Martino, M.D., Correa, L., Dos Santos, O.F., and Edmond, M.B. (2012). Catheter related bloodstream infection (CR-BSI) in ICU patients: Making the decision to remove or not to remove the central venous catheter. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0032687"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s15010-013-0494-z","article-title":"Costs and prolonged length of stay of central venous catheter-associated bloodstream infections (CVC BSI): A matched prospective cohort study","volume":"42","author":"Leistner","year":"2014","journal-title":"Infection"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1186\/s13054-020-03417-0","article-title":"Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease","volume":"24","author":"Razazi","year":"2020","journal-title":"Crit. Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.ajic.2020.10.019","article-title":"Unintended consequences of infection prevention and control measures during COVID-19 pandemic","volume":"49","author":"Wee","year":"2021","journal-title":"Am. J. Infect. Control"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s13054-021-03460-5","article-title":"Ventilator-associated pneumonia in critically ill patients with COVID-19","volume":"25","author":"Maes","year":"2021","journal-title":"Crit. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"159","DOI":"10.3201\/eid3001.230183","article-title":"Increased Peripheral Venous Catheter Bloodstream Infections during COVID-19 Pandemic, Switzerland","volume":"30","author":"Zanella","year":"2024","journal-title":"Emerg. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1017\/ice.2022.116","article-title":"Continued increases in the incidence of healthcare-associated infection (HAI) during the second year of the coronavirus disease 2019 (COVID-19) pandemic","volume":"44","author":"Lastinger","year":"2023","journal-title":"Infect. Control. Hosp. Epidemiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1086\/421946","article-title":"Nosocomial Bloodstream Infections in US Hospitals: Analysis of 24,179 Cases from a Prospective Nationwide Surveillance Study","volume":"39","author":"Wisplinghoff","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jhin.2021.08.027","article-title":"Rising rates of hospital-onset Klebsiella spp. and Pseudomonas aeruginosa bacteraemia in NHS acute trusts in England: A review of national surveillance data, August 2020\u2013February 2021","volume":"119","author":"Sloot","year":"2022","journal-title":"J. Hosp. Infect."},{"key":"ref_23","unstructured":"UKHSA (2024, October 23). Annual Epidemiological Commentary: Gram-Negative, MRSA, MSSA Bacteraemia and C. Difficile Infections, Up to and Including Financial Year 2022 to 2023, Available online: https:\/\/www.gov.uk\/government\/statistics\/mrsa-mssa-and-e-coli-bacteraemia-and-c-difficile-infection-annual-epidemiological-commentary\/annual-epidemiological-commentary-gram-negative-mrsa-mssa-bacteraemia-and-c-difficile-infections-up-to-and-including-financial-year-2022-to-2023#epidemiological-analysis-of-gram-negative-organisms."},{"key":"ref_24","unstructured":"UKHSA (2024, October 23). English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2022 to 2023, Available online: https:\/\/assets.publishing.service.gov.uk\/media\/65cf498ee1bdec001132225c\/ESPAUR-report-2022-to-2023.pdf."},{"key":"ref_25","unstructured":"PHE (2024, October 23). Laboratory Surveillance of Pseudomonas and Stenotrophomonas spp. Bacteraemia in England, Wales and Northern Ireland: 2018, Available online: https:\/\/assets.publishing.service.gov.uk\/media\/5e3c1ddced915d091ad1cada\/hpr0320_PSDMNS-18.pdf."},{"key":"ref_26","unstructured":"PHE (2024, October 23). Laboratory Surveillance of Enterobacter spp., Serratia spp. and Citrobacter spp. Bacteraemia in England, Wales and Northern Ireland: 2018, Available online: https:\/\/assets.publishing.service.gov.uk\/media\/5d557c10e5274a077fb6bb54\/hpr2919_entrbctr.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13613-014-0034-8","article-title":"Healthcare-associated bloodstream infections in critically ill patients: Descriptive cross-sectional database study evaluating concordance with clinical site isolates","volume":"4","author":"Culshaw","year":"2014","journal-title":"Ann. Intensive Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1093\/jac\/dkq088","article-title":"Antibiotic use and impact on outcome from bacteraemic critical illness: The Bacteraemia Study in Intensive Care (BASIC)","volume":"65","author":"Corona","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1128\/CMR.00036-07","article-title":"From clinical microbiology to infection pathogenesis: How daring to be different works for Staphylococcus lugdunensis","volume":"21","author":"Frank","year":"2008","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Haddad, S.F., Lahr, B.D., Patarroyo, S.S., Chesdachai, S., Kies, K.D., O\u2019Horo, J.C., DeSimone, D.C., Sendi, P., and Baddour, L.M. (2023). Bloodstream Infection Due to Coagulase-Negative Staphylococci: Impact of Species on Prevalence of Infective Endocarditis. Antibiotics, 12.","DOI":"10.3390\/antibiotics12091453"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/1\/183\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:30:06Z","timestamp":1759919406000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/1\/183"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,16]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["microorganisms13010183"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms13010183","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,16]]}}}