Replacement of by as the predominant enterococcus in UK bacteraemias.

OBJECTIVES

To review temporal changes in the proportions of different species recorded in two UK bacteraemia surveillance systems. Antibiotic resistance trends were also considered.

METHODS

We reviewed data for enterococci from 2001 to 2019 in: (a) the BSAC Resistance Surveillance Programme, which collected up to 7-10 bloodstream enterococci every year from each of 23-39 hospitals in the UK and Ireland and tested these centrally; and (b) PHE bacteraemia surveillance, using routine results from NHS microbiology laboratories in England.

RESULTS

BSAC surveillance, based upon 206-255 enterococci each year (4486 in total), indicated that the proportion of rose from 31% (212/692) in the period 2001-3 to 51% (354/696) in the period 2017-19, balanced by corresponding falls in the proportion of . PHE surveillance provided a larger dataset, with >5000 enterococcus reports per year; although its identifications are less precise, it too indicated a rise in the proportion of . BSAC surveillance for indicated no consistent trends in resistance to ampicillin (≥86% in all years), vancomycin (annual rates 19%-40%) or high-level resistance to gentamicin (31%-59%). Resistance to vancomycin remained <4% in in all years, whilst high-level resistance to gentamicin fell, perhaps partly reflecting the decline of two initially prevalent gentamicin- and ciprofloxacin-resistant clones.

CONCLUSIONS

Both surveillance systems indicate a growing proportion of in enterococcal bloodstream infections. This is important because fewer therapeutic options remain against this frequently multiresistant species than against .