Official Statistics

Supplementary results for paediatric and neonatal units, England: May 2016 to March 2025

Updated 16 October 2025

Applies to England

This supplementary report contains additional results on bloodstream infections in paediatric and neonatal intensive care units (ICUs). Given the low participation rates of such units in this surveillance programme, it is important to interpret the following results with caution. Low participation introduces potential selection bias and reduces generalisability of the findings, as the final sample may not accurately represent the overall population of interest.

Paediatric units

Trends in paediatric ICUs differed considerably from those described across adult units in the main report. This is likely due in part to the small event counts in paediatric ICUs, leading to more variability in rates. Also, as participation of paediatric ICUs was lower, with only 3 units participating in financial year (FY) 2024 to 2025 (13.0% of all paediatric ICUs identified in external audits) (supplementary Table S1), wider interpretation of trends remains difficult.

Rate of infections in paediatric units

In FY 2024 to 2025, there were 11 positive blood cultures (PBC) reported (2.4 per 1,000 bed-days) in paediatric units, of which 7 (63.6%) were considered bloodstream infections (BSI) (1.5 per 1,000 bed-days) and 5 (71.4% of BSIs) were considered ICU-associated BSI (ICU-BSI, 1.4 per 1,000 ICU days).

The rate of PBCs was 2.7 per 1,000 bed-days in FY 2017 to 2018, rising to a peak of 4.8 in FY 2019 to 2020, and dropping to 2.3 in FY 2023 to 2024. The rate of BSIs followed the same general trend. (Figure S1, supplementary Table S2).

The peaks seen across these rates do not match those seen in adult ICUs and discussed in the main report, with peaks occurring prior to the COVID-19 pandemic in paediatric ICUs. However, caution should be taken with interpreting these findings, due to small numbers. Low participation introduces potential selection bias and reduces generalisability of the findings, as the final sample may not accurately represent the overall population of interest.

Figure S1. Rates of positive blood cultures (PBC) and bloodstream infections (BSI) per 1,000 bed-days, participating paediatric units, England: between FY 2016 to 2017 [note 1] and FY 2024 to 2025

Note 1: data for FY 2016 to 2017 includes data from May 2016 to March 2017 only.

ICU-BSI rates increased from 2.3 per 1,000 ICU days in FY 2017 to 2018 to a peak of 2.7 in FY 2019 to 2020, before falling to 0.4 in FY 2023 to 2024. This sudden decrease in rate between FY 2019 to 2020 and FY 2020 to 2021 was accompanied by a halving of reported ICU days, which went from 11,486 in FY 2019 to 2020 to 5,716 in FY 2020 to 2021. The number of reported bed-days has not returned to pre-pandemic levels, partly due to decreased participation, but the incidence increased again to 1.4 in FY 2024 to 2025 (Figure S2, supplementary Table S2).

Figure S2. Rates of ICU-associated bloodstream infections (ICU-BSI) per 1,000 ICU days, participating paediatric units, England: between FY 2016 to 2017 [note 1] and FY 2024 to 2025

Note 1: data for FY 2016 to 2017 includes data from May 2016 to March 2017 only.

In FY 2024 to 2025, there were 2 cases classified as ICU-associated central venous catheter associated BSI (ICU-CABSI) in paediatric units. As with the outcomes described above, trends in paediatric ICU-CABSIs differed markedly from those observed in adult ICUs (supplementary Table S3) and fluctuated over the surveillance period (Figure S3). Again, low participation introduces potential selection bias and reduces generalisability of the findings, as the final sample may not accurately represent the overall population of interest.

Figure S3. Rates of ICU-associated catheter-associated bloodstream infections (ICU-CABSI) per 1,000 ICU-CVC days, participating paediatric units, England: between FY 2016 to 2017 [note 1] and FY 2024 to 2025

Note 1: data for FY 2016 to 2017 includes data from May 2016 to March 2017 only.

Organism distribution

Of the 11 isolates from positive blood cultures reported in paediatric ICUs in FY 2024 to 2025, 4 (36.4%) isolated were coagulase-negative Staphylococci (CoNS), only one of which met BSI definition, and one was a viridans group Streptococcus, which did not meet BSI definition. The other 6 BSI isolates identified in this year were 4 Klebsiella species and one each (9.1%) of E. coli and one other Gram-positive bacterium. The cases were defined as ICU-BSIs in one case of CoNS, as well as in the Klebsiella species cases (Figure S4, supplementary Tables S6 to S9).

Figure S4 shows organisms aggregated in 10 key groups. A more detailed breakdown of the ‘Other Gram-negative’, ‘Candida species’, and ‘Other’ groups is presented in supplementary Tables S6 to S9.

Figure S4. Rate of BSIs per 10,000 bed-days, by organism group, paediatric ICUs, England, between FY 2016 to 2017 [note 1] and FY 2024 to 2025

Note 1: data for FY 2016 to 2017 includes data from May 2016 to March 2017 only.

CVC utilisation

In paediatric units CVC utilisation was relatively stable between FY 2016 to 2017 and FY 2018 to 2019, varying between 56.1% and 56.6%. There was a small drop to a low of 52.0% in FY 2020 to 2021 before rising back to 55.8% by FY 2023 to 2024 and reaching a peak of 70.8% in the latest financial year (Figure S5, supplementary Table S3).

Figure S5. Central vascular catheter (CVC) utilisation in paediatric units, England: between FY 2016 to 2017 [note 1] and FY 2024 to 2025

Note 1: data for FY 2016 to 2017 includes data from May 2016 to March 2017 only.

Neonatal units

Trends in neonatal critical care units differed considerably from those described across adult ICUs in the main report.

This is likely due in part to the small event counts in neonatal ICUs, leading to more variability in rates. Also, participation of neonatal ICUs was much lower, with only 4 units participating in FY 2024 to 2025 (2.6% of all neonatal ICUs as identified with external audits, see Table 1 in the main report).

 Rate of infections in neonatal units

Incidence of PBCs, BSIs and ICU-BSIs in neonatal ICUs (Figures S6 and S7, supplementary Tables S2 and S3) was lower than in adult and paediatric units. There were no peaks in incidence coinciding with the COVID-19 pandemic, unlike those observed in adult ICUs.

Figure S6. Rates of positive blood cultures (PBC) and bloodstream infections (BSI) per 1,000 bed-days, participating neonatal units, England: between FY 2016 to 2017 [note 1] and FY 2024 to 2025

Note 1: data for FY 2016 to 2017 includes data from May 2016 to March 2017 only.

Figure S7. Rates of ICU-associated bloodstream infections (ICU-BSI) per 1,000 ICU days, participating neonatal units, England: between FY 2016 to 2017 [note 1] and FY 2024 to 2025

Note 1: data for FY 2016 to 2017 includes data from May 2016 to March 2017 only.

In FY 2024 to 2025, there were 9 cases classified as ICU-CABSIs (1.4 per 1,000 ICU-CVC days) in neonatal units (supplementary Table S3).

There was a large reduction in rates of ICU-CABSIs coinciding with the beginning of the COVID-19 pandemic in 2020 (Figure S8, supplementary Table S3). This finding is similar to that seen in paediatric units. However, it is the opposite of that observed in adult ICUs, where the rate of all outcomes increased in FY 2020 to 2021. However, these differences may be in part due to small numbers.

It should be noted that event counts were particularly small for catheter-associated outcomes. As such, identified trends are unlikely to be statistically meaningful.

Figure S8. Rates of ICU-associated catheter-associated bloodstream infections (ICU-CABSI) per 1,000 ICU-CVC days, participating neonatal units, England: between FY 2016 to 2017 [note 1] and FY 2024 to 2025

Note 1: data for FY 2016 to 2017 includes data from May 2016 to March 2017 only.

Organism distribution

Of the 105 isolates from PBCs reported by neonatal units in FY 2024 to 2025, the majority were CoNS (55 cases, 52.4%).

Only 12 of these met the BSI case definition, but CoNS were still the most common BSI isolates, constituting 31.6% of the 38 BSI isolates. The other main pathogens for BSIs included 8 E. coli cases (21.1%), 6 Enterococcus species (15.8%), 5 Klebsiella species (13.2%) (supplementary Tables S6 to S9).

Of note, there were no Candida species isolates reported in BSIs from neonatal units.

Figure S9 shows organisms aggregated in ten key groups. A more detailed breakdown of the ‘Other Gram-negative’ and ‘Other’ groups is presented in supplementary Tables S6 to S9.

Figure S9. Rate of BSIs per 10,000 bed-days, by organism group, neonatal ICUs, England, between FY 2016 to 2017 [note 1] and FY 2024 to 2025

Note 1: data for FY 2016 to 2017 includes data from May 2016 to March 2017 only.

CVC utilisation

CVC utilisation was much lower in neonatal units across the surveillance period compared with adult and paediatric units. In neonatal units CVC utilisation was relatively stable, varying between 18.8% and 26.9% (Figure S10, supplementary Table S3).

Figure S10. Central vascular catheter (CVC) utilisation in neonatal units, England: between FY 2016 to 2017 [note 1] and FY 2024 to 2025

Note 1: data for FY 2016 to 2017 includes data from May 2016 to March 2017 only.