Antibiotic resistance rise fears

The NHS is being warned about its use of antibiotics

The rise in antibiotic resistance is reaching worrying levels, experts say.

The Health Protection Agency said while the focus on infections such as MRSA had been largely successful, new trends in other bugs were now posing a threat.

For instance, 12% of bloodstream infections by E. coli in England, Wales and Northern Ireland now show some signs of not responding to drugs.

The HPA said the NHS must be careful over antibiotic use and urged industry to look into developing new drugs.

There are two main families of bacteria known as gram-positive, such as MRSA, and gram-negative, which includes E. coli and other less common bugs Acinetobacter and Pseudomonas.

There are some cracks in the system, but they are not big ones yet Dr David Livermore, of the HPA

The HPA said there had been a drive to tackle MRSA in recent years which had helped reduce infection rates and led to a host of new antibiotics to be developed.

By comparison, the development of antibiotics targeting gram-negative bacteria such as E coli, which can cause a range of symptoms from mild diarrohea to abdominal cramps and kidney damage, was much less common.

The fight against drug resistance is an on-going battle because many bacteria constantly mutate, gaining resistance to current antibiotics in the process.

This is what has been happening in recent years to the likes of E coli.

HPA data shows that there are about 20,000 bloodstream infections of E. coli each year – although the true level of infections would be much higher if urinary tract infections were taken into account.

Of these, 12% show signs of resistance – up from about 4% at the turn of the century.

The infections are mostly not yet resistant to all forms of antibiotics, just what doctors call the first-line.

This means they are having to use back up drugs, which tend to have more side effects and raises the prospect of the widespread emergence of a new strain which is totally antibiotic resistant.

Cases

Indeed, reports have already emerged of such a scenario in Israel and the US, while four cases have been reported in the UK.

Dr David Livermore, an infections expert at the HPA, urged industry to start looking at developing new antibiotics.

But he added: “The NHS must be careful over its use of antibiotics to slow down the development of resistance.

“Hospitals must make sure they use the right dose, for the right length of time.

“GPs should not prescribe – nor patients expect – antibiotics for routine coughs and colds.

“Resistance has been accumulating. We are having to use reserve antibiotics more than previously… that is worrying.

“There are some cracks in the system, but they are not big ones yet.”

Vein tubes ‘fitted needlessly’

Cannulas are used to help take blood and to give drugs and fluids

A third of patients have unnecessary tubes inserted into veins when they are in hospital, pharmacists have warned.

Researchers from Aberdeen’s Robert Gordon University said this needlessly exposed them to serious complications, such as infections and blood clots.

Just under 350 patients were studied over six weeks, the majority of whom had the tubes, called cannulas, fitted.

An A&E expert recognized cannulas should be used less frequently and for shorter periods.

It’s entirely reasonable to look at their use Dr Martin Shalley, emergency medicine consultant

The study was presented to the British Pharmaceutical Conference in Manchester.

Cannulas – hollow plastic tubes with a needle at the tip which cost around £1.70 each – are used to give medication and fluids to people who cannot swallow because they are unconscious or being given nil by mouth, and it has been estimated that around 80% of hospital patients have them fitted.

Drugs may also be more easily absorbed if given this way.

But potential complications include problems with veins (phlebitis), drugs leaking into tissues around the site of the tube, serious infection and blood clots.

‘Common practice’

Of the patients studied – who were all treated in the acute medical assessment unit of Aberdeen Royal Infirmary, 91% of patients had a cannula inserted. But 28% of the tubes were never used.

The researchers also found that in 71% of patient records there was no documentation of a cannula being inserted, while in 57% there was no documentation of it being removed.

Four patients had developed blood poisoning, which infection control specialists said was likely to be linked to the cannula.

The researchers, led by Dr Yash Kumarasamy, said that in many UK hospitals, it has become common practice to insert an intravenous cannula when the patient is admitted, irrespective of need.

He said: “We would like to see the introduction of a formal procedure under which hospital pharmacists review patients and their medications and make recommendations to the treatment team about whether or not a cannula is needed.”

Dr Martin Shalley, a former president of the British Association of Emergency Medicine, agreed there had been an over-reliance on cannula use.

He said many trusts had policies saying cannulas had to be removed after 72 hours

“It used to be a knee-jerk response to insert a cannula – but we now recognise there’s a need to think if fitting one is a benefit for that patient.

“It’s entirely reasonable to look at their use. That’s the case in A&E medicine and across acute medicine too.”

And Dr Shalley said he thought the level of use of cannulas had increased the level of hospital-acquired infections such as MRSA.