Escherichia coli bacteraemia, Clostridioides difficile infection and antibiotic prescribing in South West London: a decade of surveillance before and after COVID-19.

BACKGROUND

Escherichia coli bacteraemia and Clostridioides difficile infection (CDI) are core indicators of infection prevention and control and antimicrobial stewardship (AMS) in England, but subregional longitudinal trends are under-reported.

AIM: The aim of this study was to describe trends in E. coli bacteraemia, CDI and community antibiotic prescribing in South West London (SWL) over a decade, compared with England, across prepandemic, pandemic and post-COVID recovery phases.

METHODS

A retrospective ecological analysis of publicly available UK Health Security Agency surveillance datasets was conducted. Annual rates of E. coli bacteraemia and CDI per 100,000 population and total antibiotic items prescribed in the community per 1000 population per day were examined across 2014/15-2019/20, 2020/21-2021/22 and 2022/23-2023/24. Descriptive statistics and year-on-year percentage change were used.

RESULTS

E. coli bacteraemia rates in SWL were stable at around 58 per 100,000 before the pandemic, fell to 48.3 in 2020/21, and rose to 60.8 by 2023/24. England showed the same pattern at higher absolute rates. CDI rates in SWL remained within a narrow band across the decade, from 14.0 to 18.8 per 100,000, with little net change overall, whereas England showed a sustained post-2021 rise reaching 29.5 by 2023/24. Community antibiotic prescribing declined during the pandemic and returned to near baseline in both SWL and England.

CONCLUSIONS

SWL maintained comparatively stable CDI rates across the study period, while E. coli bacteraemia rebounded after the pandemic and remained harder to reduce. These findings highlight the importance of closer alignment of infection prevention and AMS at integrated care board level.