MRSA and C difficile deaths continue to fall in England and Wales

BMJ 2013; 347 doi: (Published 27 August 2013) Cite this as: BMJ 2013;347:f5278
  1. Andrew Cole
  1. 1London

Deaths involving Clostridium difficile and meticillin resistant Staphylococcus aureus (MRSA) have fallen for the fifth year running in England and Wales, according to latest figures from the Office for National Statistics, with MRSA deaths now at their lowest for nearly two decades.

The number of death certificates mentioning C difficile fell by 20% between 2011 and 2012, from 2053 to 1646.1 Death certificates mentioning MRSA fell by a similar proportion, from 364 in 2011 to 292 in 2012.2

The number of death certificates giving C difficile as the underlying cause of death was 674 in 2012 compared with 858 the previous year. MRSA was given as the underlying cause of death in 38 cases compared with 65 in 2011.

Health Minister Norman Lamb said that the NHS had worked hard to achieve these reductions. “However, we have been absolutely clear that the NHS should take a zero tolerance approach to all avoidable healthcare associated infections and there should be more progress,” he added. “All hospitals and care settings should be performing at the standard of the best and this is what the NHS must provide.”

The latest figures represent a significant drop compared to the peak five to six years ago when the number of deaths involving C difficile stood at 8324 (2007) and those involving MRSA at 1652 (2006) (figure). The number of C difficile deaths is now at its lowest since 2002, while MRSA deaths are at their lowest since 1995.

The age standardised mortality rate for C difficile in England and Wales fell from 19.6 deaths per million in 2011 to 15.3 deaths per million in 2012. This compares with a peak of 83.9 deaths per million in 2007 but is still higher than the 12.9 deaths per million in 2001.

The highest death rates from C difficile are in the north east (23.9 deaths per million) followed by West Midlands (19.2) and the North West (18.3), while the lowest rates are in the south east (10.7). However, all regions are following the national pattern of declining death rates.

The proportion of C difficile deaths in NHS hospitals fell from 92.4% to 89.7% between 2007-09 and 2010-12, while the proportion in care homes (5.3% to 6.7%), homes (1.3% to 1.9%), and hospices (0.8 to 1.4%) rose—although the actual number of deaths in all settings has decreased.

Between 2008 and 2012, 86.6% of deaths from MRSA in England and Wales occurred in NHS hospitals, while 9.6% were in care homes and 1.9% at home. Most care home deaths were in non-local authority care homes.

MRSA and C difficile death rates rise consistently with age and are highest among those aged 85 and over. The rate of C difficile deaths per million was 812 in those aged 85 or over, for instance, compared with 235 in the 75-84 age bracket. C difficile death rates are also higher in men than women. The death rate for men aged 85 or over is more than double the rate for women in the same age bracket (415.8 deaths per million compared with 200.4 deaths per million).


Cite this as: BMJ 2013;347:f5278


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