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.”

Russian forces battle Georgians

Russian forces are locked in fierce clashes with Georgia     inside its breakaway South Ossetia region, reports say, amid fears of all-out war.

Moscow sent armoured units across the border after Georgia moved against Russian-backed separatists.

Russia says 12 of its soldiers are dead, and separatists estimate that 1,400 civilians have died.

Georgia accuses Russia of waging war, and says it has suffered heavy losses in bombing raids, which Russia denies.

Russian tanks have reportedly reached the northern suburbs of the regional capital, Tskhinvali, and there were conflicting claims about who was in control of the city.

“Now our peacekeepers are waging a fierce battle with regular forces from the Georgian army in the southern region of Tskhinvali,” a Russian military official was quoted as saying by Moscow-based news agency, Interfax.

After days of exchanging heavy fire with the separatists, Georgian forces moved on Thursday night to regain control of the region, which has had de facto independence since a war against Georgia that ended in 1992.

I saw bodies lying on the streets, around ruined buildings, in cars. It’s impossible to count them now Lyudmila Ostayeva Tskhinvali resident

Georgian President Mikhail Saakashvili said Russia was at war with his country.

He told the BBC: “Our troops are attacked by thousands of troops coming in from Russia.”

Mr Saakashvili said Georgia had shot down several Russian planes and accused Moscow of bombing Georgian air bases and towns, resulting in the death of 30 military personnel and civilians.

Late on Friday, the Georgian national security council said Mr Saakashvili was poised to declare a state of emergency.

Despite denials from Moscow, the Russian air force has been carrying out air raids in South Ossetia and Georgia itself, says the BBC’s Richard Galpin, in Gori, eastern Georgia.

‘Ethnic cleansing’

Russian President Dmitry Medvedev said he had to act to defend South Ossetia’s civilians, most of whom have been given Russian citizenship.

He also voiced anger over the reported fatalities of Russian servicemen in the breakaway province.

“We will not allow their deaths to go unpunished,” he said. “Those responsible will receive a deserved punishment.”

Russian Foreign Minister Sergei Lavrov said Moscow had received reports that villages in South Ossetia were being ethnically cleansed.

The BBC’s Matthew Collin in Tbilisi says battles continue around Tskhinvali with the sound of explosions, rocket fire and military planes flying overhead.

The regional capital, where inhabitants are said to be sheltering in basements without electricity or phone lines, is reported to be devastated.

SOUTH OSSETIA TIMELINE 1991-92 S Ossetia fights war to break away from newly independent Georgia; Russia enforces truce 2004 Mikhail Saakashvili elected Georgian president, promising to recover lost territories 2006 S Ossetians vote for independence in unofficial referendum April 2008 Russia steps up ties with Abkhazia and South Ossetia July 2008 Russia admits flying jets over S Ossetia; Russia and Georgia accuse each other of military build-up 7 August 2008 After escalating Georgian-Ossetian clashes, sides agree to ceasefire 8 August 2008 Heavy fighting erupts overnight, Georgian forces close on Tskhinvali

Fleeing resident Lyudmila Ostayeva, 50, told AP news agency: “I saw bodies lying on the streets, around ruined buildings, in cars. It’s impossible to count them now. There is hardly a single building left undamaged.”

International Red Cross spokeswoman Anna Nelson said it had received reports that hospitals in Tskhinvali were “overflowing” with casualties.

In other developments:

• The UN Security Council fails to agree a statement on the crisis, despite holding a second session of talks on Friday evening
• US Secretary of State Condoleezza Rice called on Russia to pull its troops out of Georgia and respect its territorial integrity
• Georgia’s president said his country was withdrawing half its contingent of 2,000 troops from Iraq to help deal with the crisis
• Russia said it would cut all air links with Georgia from midnight on Friday
• The European security organisation, the OSCE, warned that the fighting in South Ossetia could escalate into a full-scale war
• The US and the EU were reported to be sending a joint delegation to the region to seek a ceasefire and Nato said it was seriously concerned