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5 News - Global warning over resistance of antibiotics to superbugs

May 19, 2016

If the world doesn't take action now, superbugs will kill someone every three seconds within a generation. That's the stark warning from a global study into antibiotics, which says we're overusing them and failing to develop enough new ones. The report says in future, basic procedures we take for granted could become too dangerous to carry out.

The battle against drug resistant infection

May 19, 2016

The battle against infections that are resistant to drugs has been described as "big a risk as terrorism", according to a new report. The Review on Antimicrobial Resistance says superbugs will kill someone every three seconds by 2050 unless the world acts now. Joanna Gosling spoke to Professor Laura Piddock, who advised on the report, Yvonne Smith, who lost her father to a superbug infection, Derek Butler, from charity MRSA Action UK, Sharon Brenan, a transplant patient and health journalist and Professor Paul Cosford from Public Health England. More...

MRSA Action UK respond to media on NICE antimirobial stewardship and plans to penalise GPS who 'over-prescribe'

18 August 2015

The use of antibiotics has risen steadily over recent years with 41.6 million NHS prescriptions issued last year in England alone at a cost of £192m. Nine out of ten GPs say they feel pressurised to issue the prescriptions and 97 per cent of patients who ask for them are prescribed them. Between 20 and 30 per cent of antibiotics currently prescribed by the NHS are unlikely to benefit patients, for example because they are suffering from a throat virus – one of the most common reasons for taking a course of antibiotics.

Derek Butler, Chair of MRSA Action UK was interviewed by Channel 5 News and on BBC Radio London giving our viewpoint and spoke about the impact of antimicrobial resistance on families in the reports.

MRSA Action UK is calling for education for both prescribers and the public. In its response to the consultation on the NICE quality statement on antimicrobial stewardship the charity asked for the provision of antimicrobial pharmacists and improved diagnostic tools to speed up the process of identifying organisms that cause infections. There is, we feel, an emphasis needed on prescribing the correct antimicrobial at the right time. Without the training and tools of the trade this is a challenge for prescribers. Derek advised that we have to preserve these powerful drugs or we would be facing a future where the simplist of infection will be untreatable, and return to the pre-antibiotic era. View our press release for more information

Dangers of the doctors and nurses who still don't wash their hands: MP who lost her father to superbug vows to clean up NHS

Andrea Jenkyns is the new Conservative MP for Morley and Outwood. Her father Clifford died from a hospital-acquired MRSA infection in 2011. Following his death Andrea became MRSA Action UK regional representative

MP says: 'Handwashing must be part of training'

PUBLISHED: 23:20, 15 June 2015 | UPDATED: 00:35, 16 June 2015

To those who watched the General Election results come in, Andrea Jenkyns is the woman who provided 2015's 'Portillo moment' as she unexpectedly unseated the former shadow chancellor, Ed Balls, and became the new Conservative MP for Morley and Outwood.

As she stood on the podium smiling, one person played heavily on her mind - her father Clifford. It was largely his premature death from a hospital-acquired infection in 2011 that prompted the former music teacher and singer to move into politics.

Clifford had mesothelioma, lung cancer, brought on by exposure to asbestos.

'He was a lorry driver in the Fifties and Sixties and was transporting asbestos sheets everywhere - people weren't aware of the risks back then,' says Andrea. But the prognosis was good as the cancer had been spotted at an early stage. Clifford, a former boxer, then 73, was told that with surgery to remove it he could expect to live another ten to 20 years. His only symptom was slight breathlessness.

Tragically, however, he would be dead within four months - not from the cancer, but from an infection he picked up during a routine procedure in hospital.

Losing her father so unexpectedly and so needlessly had a big effect on Andrea, now 40. 'He was my hero, he was a fantastic dad, such a good man,' she says quietly.

'He wasn't bitter and we aren't bitter as a family, but it's not easy - his death was entirely unnecessary.'

Clifford went into Pinderfields Hospital in Wakefield in July 2011 to have fluid drained from his lung. It had collected as a result of the cancer and was hampering his breathing. His family was told it would be a quick procedure that would take at most 20 minutes. In fact it took two and a half hours.

'When he went in, there was a consultant overseeing some trainees and they practised taking the drainage tube out of Dad and putting it back in,' says Andrea. 'Dad - who had only had local anaesthetic - said he saw blood spurting out, but he was a tough man and wouldn't admit if it was hurting.

'What we found out later was that they did the procedure in a room where the cleaners kept their mop buckets; the door was kept open all the time and next door were people who had infections such as MRSA and clostridium difficile.'

After the procedure, Clifford went straight home. But within 24 hours it was apparent that he was not right; the wound site smelled and he seemed hot and unwell.

The next day Andrea's sister took him back to hospital, where tests showed he had MRSA.

As the infection took hold, Andrea witnessed her once strong father transform into a shadow of his former self. At times he was halluncinating and barely compos mentis. His weight plummeted to 7st, extremely frail for his 5ft 9in frame.

Despite the fact that her father was being treated for hospital-acquired infection, Andrea could only watch in horror as some of the staff didn't observe simple hygiene precautions.

They did the procedure in a room where the cleaners kept their mop buckets; the door was kept open all the time and next door were people who had infections 'Many times we had doctors and nurses coming in and out who didn't wash their hands,' she says. 'When you have MRSA they put antibacterial cream up your nose.' This is because the warm moist environment in the nose makes it a hot spot for MRSA.

'On one occasion a nurse walked in, put a bit on her bare finger shoved it up Dad's nose and walked back out without washing her hands. 'When I followed her back to the nurses' station and asked her why she hadn't washed her hands, I was met with blank looks.'

For four months Clifford was shuttled between home and hospital, but the infection proved resistant to all the antibiotics tried on him and he died at home in November 2011 with his wife Valerie present. 'I had just popped home to get some clothes when Mum called to say Dad had died,' recalls Andrea.

'I went straight back. He was on the floor - Mum had tried to do CPR - and I held onto his tummy, it was the last piece of warmth to him. I was trying to hang onto the last bit of life in him, I didn't want him to go.'

The post-mortem confirmed Clifford had died of MRSA acquired in hospital. MRSA, or meticillin-resistant staphylococcus aureus, is caused by a type of bacterium, staphylococcus, which is resistant to many antibiotics - around 1 per cent of us carry these bacteria on our skin.

If the bacteria get into the bloodstream - and it takes only a tiny nick in the skin for this to happen - they can be very difficult to treat.

In 10-20 per cent of cases they prove fatal, as the bacteria can cause blood poisoning. While MRSA infection rates have dropped more than 70 per cent since their peak a decade ago, figures published last week by Public Health England show that cases are slowly pushing upwards again. The number of cases reported between January and March this year has increased by just over 9 per cent compared with the same period last year.

Derek Butler, of the charity MRSA Action UK, says: 'We have done very well at getting infection rates down over the past few years but there is a fear that people are beginning to take their eye off the ball.'

And it's not just MRSA. Cases of clostridium difficile, another infection that can commonly be acquired in hospitals and other healthcare settings, such as nursing homes, is also on the rise. C.diff is a bacterium that causes infectious diarrhoea and is spread in the faeces of an infected person.

The bacteria produce spores that can survive on surfaces and are then transferred by people touching that surface and passing on the bug.

C.diff can prove deadly to someone whose immune defences are low, such as an elderly person, or someone taking broad spectrum antibiotics, as these also wipe out many of the helpful bacteria that play a part in your immune system, explains Dr Tony Worthington, a clinical microbiologist at Aston University.

From January to March 2015, the number of C.diff cases rose by 12 per cent, from 3,006 to 3,888 compared with the same point last year; the number of cases reported by hospital trusts has increased by 17 per cent again compared with the same period last year.

So what is behind the rise? According to Dr David Jenkins, consultant medical microbiologist and lead infection prevention doctor, University Hospitals of Leicester NHS Trust, hygiene is the key.

Andrea wants to see monthly posters displayed in hospitals, showing the faces of those who have died of a hospital-acquired infection. 'Keeping these infections down involves three things: good hand hygiene, good environmental hygiene (such as keeping wards clean) and the proper use of antibiotics,' he says. 'However, people move on and those healthcare professionals who were around in 2006 when infections were at their peak have in many cases gone.

'So in some cases we are now having to remind people of the importance of good hygiene. Many people - even some healthcare professionals - think infection control is done and dusted and MRSA and C.diff have gone away. But they haven't - and in my opinion these are just the warm-up acts to the multi-drug resistant bugs we could face in the future.'

Already he says some hospitals are having difficulties with the number of drug-resistant E.coli cases.

Last year, the National Institute for Health and Care Excellence called on doctors and nurses to redouble their hygiene effort to bring down 'unacceptable and avoidable infection rates'.

It emphasised one in 16 people treated by the NHS still acquires an infection of some kind, highlighting hygiene - and basic hand washing - as one key to reducing figures.

From what she has seen, Andrea Jenkyns believes the message is still not getting through.

Following her father's death Andrea joined MRSA Action UK. She and her mother became trustees and Andrea became the regional representative, getting involved with patient-led inspections on behalf of the Department of Health.

A year after her father died she went to a health conference to give a talk about the importance of hand hygiene to 400 nurses and doctors.

When she asked how many believed hand washing could save lives, she was 'shocked' by how few raised their hands. It helped fuel her determination to get more involved in politics - she was already a county councillor when her father died.

'After what happened I thought the only way to make a difference is to be on the inside and policy making,' she says.

She fears there is still much work to be done. In the past fortnight she has been visiting an elderly constituent with C.diff whose family contacted her about their concerns about hygiene in a hospital.

'They told me a temporary nurse walked into a lady's room and plugged her phone charger into a socket - even though the lady had C.diff.'

Andrea would like to see less tolerance of those healthcare workers and hospital visitors who don't wash their hands.

'Handwashing must be part of training and if people don't do it they should be subject to a hospital's disciplinary procedures,' she says. 'In food factories people wash their hands all the time - and in hospital we are dealing with people's lives.

She also wants to see monthly posters displayed in hospitals, showing the faces of those who have died of a hospital-acquired infection.

'It's to humanise the statistics - to show these people who died needlessly were someone's dad, someone's sister, someone's daughter. That could help get the message across - that washing hands saves lives.' Read the full article on the Daily Mail website

How soprano singer MP who beat Ed Balls was inspired to enter politics after seeing her father die from MRSA he contracted in NHS hospital


PUBLISHED: 12:33, 8 May 2015 | UPDATED: 19:22, 8 May 2015

The Conservative candidate who ended the career of Ed Balls today is a successful businesswoman, talented soprano and former beauty queen who entered public service after her father was killed by a superbug he caught in hospital.

Miss Andrea Jenkyns took the biggest scalp of the election by defeating the Shadow Chancellor in the Morley and Outwood constituency.

Mr Balls had a majority of more than 1,000, and hoped to become Chancellor under Ed Miliband - but Miss Jenkyns beat him by 422 votes as the Tories swept to an overall majority.

Inspiration: New MP Andrea Jenkyns was inspired to enter politics by the death of her father Clifford

In her victory speech, she referred to the tragic death of her 'beloved' father Clifford - saying that the reason she stood for Parliament was to boost the NHS in memory of him.

Miss Jenkyns, 40, said: 'I lost my dad in unfortunate circumstances and I just wanted to go in to make the NHS a better place for all.'

Mr Jenkyns, a lorry driver, went into hospital in July 2011, at the age of 73, for a cancer operation which would have given him another 10 years of life.

However, while awaiting surgery at Pinderfields Hospital in Wakefield, West Yorkshire he contracted MRSA, the deadly superbug which has affected dozens of Britain's hospitals.

He struggled against the bug for four months, but died in November that year - leaving Miss Jenkyns and her mother Valerie devastated.

Miss Jenkyns began campaigning to raise awareness among doctors of the dangers of MRSA in an effort to spare other families the same agony.

In an interview last year, she described addressing an audience of healthcare professionals and asking them,

'Do you believe that simply washing your hands can save a life?'

She said: 'Shockingly, very few put their hands up to agree with this statement.

'I have personally seen doctors and nurses forget to wash their hands when treating patients, I have also seen visitors to hospitals not wash their hands when visiting loved ones.'

Horror: Mr Jenkyns pictured on his deathbed in an image released by his family to raise awareness of the danger of the MRSA superbug

Today Miss Jenkyns said that her father's death had '100 per cent' influenced her policy priorities, which she characterised as 'health, education, business and jobs'.

It is fair to say that Andrea Jenkyns' path to Westminster was not always pre-ordained.

The daughter of a lorry driver, she left school at 16 to become a shop assistant, only retraining into politics last year after graduating with a degree from the University of Lincoln aged 40.

Meanwhile Ed Balls, who she defeated by 422 votes in Morley and Outwood, had a far more presdigious path laid before him.

Andrea Jenkyns, daughter of a lorry-driver father, defeated Ed Balls, son of a prominent left-wing academic, in Leeds early this morning, capping off a torrid day for Labour

The son of a prominent left-wing academic, he attended private Nottingham High School before going on to study Politics Philisophy and Ethics at Kebel College, Oxford - the same college his father attended.

From there he was taken straight to the bubble of Westminster, working briefly for the Treasury, before being whisked away to study for a masters at Harvard on the John F Kennedy scholarship.

After graduating with a first, he returned to the UK he worked as a columnist for some of the country's biggest left-wing papers, including the Financial Times and the Guardian.

It was not long before Balls was taken back to the treasury under the wing of Gordon Brown, where he remained until Brown was ousted in 2010.

Meanwhile Miss Jenkins was busy making her way in the world, working her way from shop assistant to manager, including a stint in charge of the All Sports store in Hull city centre.

From there she went on to management roles elsewhere, spending 15 years at the helm of multi-national corporations.

While Mr Balls attended fee-paying schools, followed by Oxford and Harvard before being taken under the wing of Gordon Brown Miss Jenkyns left school at 16 to work in shops, clawing her way to the top With few qualifications to her name, she did manage to obtain a BTec in business and finance while still working in shops.

Without scholarships to help her along, she was forced to take out a second job as a music tutor at three local state primary schools, eventually including private sessions to boost her income further.

A talented soprano signer, she released an album in the mid 2000s entitled Ilyis, before taking the plunge and retraining in her late 30s, completing an Open University diploma in economics alongside her singing career and other jobs.

Her move to politics began two years ago when she was chosen as the candidate to try and unseat Balls while studying for a degree in international relations and politics from the University of Lincoln.

Last night, in one of the greatest election defeats for Labour in living memory, Miss Jenkyns unseated Balls, who would have become Chancellor in a Miliband government.

Read the full article on the Daily Mail website

BBC Radio 4 - The Report
7 May 2015 - 8.00pm

Drug Resistance

Why drug resistance is now regarded by the UK government as one of the most severe threats to public safety. Peter Marshall reports.

Derek Butler and Maria Cann join the debate on BBC Radio 4

MRSA Action UK proposal to the government

Healthcare Infections A Manifesto 2015
29 April 2015

With growing problems with antimicrobial resistance, reductions in Clostridium difficile disease stalling at around 20,000 recorded cases a year, and 14,000 Staph bloodstream infections a year – the micro-organism involved in the evolution of MRSA - MRSA Action UK calls for cross-party support in "Healthcare Infections a Manifesto 2015"

the sun

Conservative Andrea could pull off shock of the election by ousting Ed

April 10, 2015, By Kevin Schofield, Chief Political Correspondent

andrea jenkyns

She is the unknown blonde soprano singer who gave up her job two years ago to run for Parliament - and now has Ed Balls running scared.

Meet Tory candidate Andrea Jenkyns, 40, who could pull off the shock of the General Election by ousting the Shadow Chancellor. Tory strategists believe Ms Jenkyns could overturn Mr Balls' wafer-thin 1,100 majority in Morley and Outwood, in west Yorkshire.

As political upsets go, it would be up there with Michael Portillo famously losing his seat to the then unknown Stephen Twigg in 1997. And while Mr Balls remains the favourite to hang on in the key marginal, The Sun has learned that his Conservative rival is now breathing down his neck.

Yorkshire-born Ms Jenkyns also has form for winning seemingly impregnable Labour seats. While living in Lincolnshire, she won the local borough council seat of Boston North West, despite the fact that it had been solid Labour territory for years. After spending the last two years tirelessly campaigning in Morley and Outwood, she believes she is on the verge of pulling off another major upset. She said: "My dad always used to say 'nothing ventured, nothing gained'. "The seat is definitely winnable."

It was the tragic death of her ex-lorry driver dad Clifford in 2011 that set Ms Jenkyns on the path that could lead her all the way to the Commons. He was admitted to hospital in Wakefield, west Yorkshire, with fluid on his lungs. But he contracted the hospital superbug MRSA and died shortly afterwards.

Grief-stricken Ms Jenkyns became active with the campaign group MRSA Action UK, and eventually moved back to Yorkshire to live with her mum, Valerie. It meant giving up her job as a music teacher and her council seat, but her political ambitions were undimmed.

She applied to be the Conservative candidate in Morley and Outwood and, following an open primary election, was selected in 2013.

As well as teaching music in various schools, she has also performed around the world - including in Pakistan - and has released an album of her own songs.

Ms Jenkyns even suggested that she and Mr Balls - who has fought a well-documented battle to master the piano - perform together to raise funds for Help for Heroes. But unfortunately, the Labour heavyweight turned down the offer as he didn't believe he was good enough yet to perform in concert.

David Cameron and George Osborne have both visited the seat to campaign on Ms Jenkyns' behalf, and are expected to return before polling day - in a huge vote of confidence in her chances.

the express

UK HEALTH ALERT: Deadly flesh-eating SUPER BACTERIA 'USA300' could be in YOUR home

MILLIONS of Britons could be unwittingly sharing their homes with a DEADLY new super-bacteria, it has emerged.

By NATHAN RAO 18:32, Fri, Mar 27, 2015 | UPDATED: 10:33, Tue, Apr 7, 2015

The killer bug which causes blood poisoning, heart failure and death is feared to be lurking in thousands of households across Britain.

It can survive unnoticed for up to 10 years before causing serious illness with researchers claiming we are on the verge of an "epidemic".

The shock warning has been sparked by the discovery of a strain of MRSA in the homes of people who only tested positive between two and nine years later.

Researchers concluded the germ, which is resistant to antibiotics, is silently lurking in the community waiting to infect new hosts.

Those who test positive for MRSA should be treated immediately to "bring the epidemic under control", according to medics writing in the journal mBio.

They warn it is "virulent and easily-transmissible" and can lead to flesh-eating diseases, pneumonia, and endocarditis - an infection of the lining of the heart.

The study, conducted in the US, found a strain of the bacteria - USA300 - can live for years in houses slowly evolving and mutating by picking up DNA from other bacteria.

People who had been exposed to the bug were not diagnosed with symptomatic infections until eight years later in some cases.

Researchers concluded they were acting as carriers of the disease and could have been passing it on without realising.

The Methicillin Resistant Staphylococcus Aureus bacteria could also be silently thriving on pets and other tiny organisms in the home, they said.

Experts fear several strains - including the lethal USA300 - are thriving in Britain without being detected until it is too late.

The report states: "We showed in this study that USA300 persisted within households for about two to eight years before a symptomatic patient was admitted to a hospital.

"This could be caused by a combination of long-term asymptomatic human carriage and/or frequent reinfections from other household members, pets, or fomites[objects you touch].

"We need to understand how MRSA persists, the reasons may be different in different households, to design strategies and public health programs aimed at controlling the spread.

"Interventions may need to address all of the symptomatically infected and asymptomatically colonised individuals in a household."

A similar epidemic may be on the verge of erupting in the UK with the number of diagnoses rising by more than 10 per cent in the past 12 months.

Official Government figures reveal there were 79 new cases of MRSA reported in British hospitals in January alone.

Though the latest study was carried out in the United States, experts warn USA300 "undoubtedly" exists in Britain.

Derek Butler, chairman of charity MRSA Action UK ( , said the Government is "panicking" about a potential crisis.

He said: "They say they have got this under control but they haven't, I have been in meetings and you can see the panic on their faces.

"If there is an outbreak it will not only cost a lot of money but is a serious situation, we must introduce universal screening for everyone who enters hospital.

"People carrying this are slipping through the net, and it is spreading, we have no idea just how prevalent it is in the community."

Two strains of MRSA have long been known to exist in the UK - hospital acquired and community acquired.

Mr Butler explained hospital acquired MRSA is passed on from patient to patient and by health professionals whereas community acquired needs no contact.

He said: "We know that it can live on inanimate objects for months and now, through this new study, we find out this could be for years.

"It is very easily spread, so there is no doubt the strain identified in the US is already in the UK and we just don't know about it.

"Although people can carry it harmlessly if it gets into cuts or scratches it can be very serious, it is very worrying."

The UK's Health Protection Agency states: "People who carry MRSA do not look or feel different from anyone else.

"Some people carry MRSA for just a few hours or days, but other people carry MRSA for weeks or months.

"Patients who have an infection may develop signs and symptoms, such as a high temperature or a fever.

"Infection and prevention control teams monitor levels of MRSA in their own hospitals."

Read the article on the Express website

The antibiotics apocalypse: It's frightening how many Britons are dying from bugs that have grown resistant from overuse of antibiotics. Now a new mutant breed's spreading that NOTHING can treat

Bacteria around the world are acquiring new ways to beat our antibiotics. These mutant bacteria are known to have killed more than 20 people in UK. They have infected hundreds, if not thousands - no one knows the true toll

By John Naish for The Daily Mail PUBLISHED: 01:23, 13 March 2015 | UPDATED: 10:23, 13 March 2015

Albert Alexander, a 43-year-old Oxford policeman, made world history in March 1941. While pruning roses, he scratched the side of his mouth.

Two strains of bacteria - staphylococcus and streptococcus - invaded the wound, producing lethal abscesses on his eye, face and lungs.

The threat of such agonising infections haunted everyone in those days. Since the dawn of humankind, people had regularly been killed by bacteria from minor wounds, or through infections from childbirth or surgery.

There were no effective treatments for pneumonia, gonorrhoea or rheumatic fever. Hospitals were full of people with blood poisoning. Doctors could do little for them.

But PC Alexander was the first patient ever to receive the wonder-drug penicillin. Within days of the first shot, his temperature dropped and his appetite returned. Stocks of the new antibiotic were minuscule, however. Doctors at the Radcliffe Infirmary desperately recycled penicillin from Alexander's urine to keep it in his bloodstream, but after five days all supply ran out. The infection raged again, killing him.

Today we are being thrown back to the world of PC Alexander, where an everyday scratch could spell death.

However, this is not because we don't have enough antibiotics. The opposite is the case. We are using far too many of them - and unnecessarily so. Thus, by our over-prescription, we teach ordinary bugs to become antibiotic-immune superbugs.

Bacteria around the world are rapidly acquiring an alarming new way to beat our best antibiotics, as if arming for a doomsday showdown with humanity.

These mutant bacteria, which carry a fragment of DNA called NDM-1, are known to have killed more than 20 people in Britain and infected hundreds, if not thousands. No one knows the true toll.

magnified MRSA

Antibiotic-resistant germs first made headlines in the Eighties with MRSA (magnified under a microscope)

Antibiotic-resistant germs first made headlines in the Eighties with MRSA. This was a new strain of the Staphylococcus aureus bacteria that normally lives harmlessly on the skin and in the noses of one in three of us.

The emerging strain of Staphylococcus had learned to shrug off strong antibiotics, most notably meticillin - hence its name, Meticillin Resistant Staphlococcus Aureus. The official annual death toll in England from MRSA peaked at 1,652 in 2006. Most victims were infected while in hospital.

Susan Fallon, of Newcastle in Staffordshire, knows only too sadly the terrible toll of MRSA. She lost her 17-year-old daughter, Sammie, to it in 2008. Sammie had been admitted to University Hospital of North Staffordshire for blood tests on a suspected viral infection.

A needle was pushed into her hip to take a bone marrow sample.

Three days later, while still in hospital, Sammie complained that her hip had swelled at the needle site. "Within a week, the swelling had got worse," says Susan. "Three days later a nurse gave me a leaflet about MRSA. I had vaguely heard of it. My mother, who had been a nurse, was with me. I saw from Mum's face that was bad."

The infection rapidly invaded Sammie's lungs and other vital organs, beating the hospital's strongest antibiotics. She began to have fits, then lost consciousness. Her kidneys failed and she was put on dialysis. Two days later she died.

The death certificate recorded the cause of death as multi-organ failure, MRSA, septicaemia and a viral infection. "I was advised to sue the hospital, but after three years, the solicitor said that we couldn't identify which nurse had put the needle into her hip and we couldn't prove our case.

"Sammie was screened for MRSA on admission and found free of the bacteria," Susan adds. "But we can't prove legally how she got it. The hospital has never apologised."

Liz Rix, the trust's Chief Nurse, told the Mail: "In the seven years since Miss Fallon's care, the trust has improved infection-prevention procedures to radically reduce the number of MRSA bacteraemia contracted by patients in our hospitals from 70 in 2008 to just five in 2014."

Across the NHS, improved infection control has significantly cut hospital deaths from MRSA, which is spread by touch. In 2012, MRSA was recorded 292 times on English death certificates - 1,360 down from the peak. However, that hopeful news is quashed by the fact that many other antibiotic-resistant bacteria are on the march.

Last October, a report from Public Health England warned that overall, infections by such bacteria had increased between 2010 and 2013. For example, infections caused by E.coli that were resistant to key antibiotics had risen by more than 10 per cent. Drug-resistant versions of other infections, such as pneumonia and gonorrhoea, are also growing.

Meanwhile, antibiotic prescribing by GPs and hospital medics has increased by 6 per cent. More than 40 million such prescriptions are believed to be written a year by GPs. Often these are for colds, coughs and flu - caused mostly by viruses, which antibiotics cannot treat. GPs claim that they often feel under pressure to prescribe from patients.

Mark Lloyd Davies, the chair of the antibiotic network at the Association of British Pharmaceutical Industries

Our society is hooked on the fading promise of these wonder-tablets, even if they won't work. Too often, doctors are happy to oblige, just to clear their consulting rooms. Antibiotics certainly have had a wondrous effect. Largely thanks to them, between 1944 and 1972, our life expectancy jumped by eight years. I owe my own life to them. Aged six months, I contracted double pneumonia. This was in 1964, less than two decades after the medicines became available. The drug that saved me back then would most likely not work nowadays due to the resistance bacteria has built over the years. Our magic swords have been beaten blunt by overuse.

The authorities have tried repeatedly to stop family doctors worsening the crisis.

In 2009, the European Centre of Disease Prevention and Control wrote to every GP in Britain, telling them to stop prescribing antibiotics unnecessarily. Since then, campaign after campaign has been mounted to persuade GPs to kick their prescription habit, by organisations such as the Royal College of General Practitioners as well as the nurses' and pharmacists' professional bodies. All have failed. Now the medicines watchdog, NICE, is proposing that we bribe doctors to change their ways.

NDM1 bacteria

NDM-1 (pictured) is an enzyme - a mutant piece of DNA - that turns ordinary bacteria into lethal bugs which our best bullets bounce off. It is also immune to most other antibiotics, including penicillins

Last month, it proposed that GPs be paid extra for not doling out antibiotics unnecessarily. Antibiotics are not a human invention. Nature used them for millennia before we learned the trick in 1928, after Alexander Fleming noticed how a green mould in his lab was killing bacteria on a specimen dish.

But in the Fifties, humans began carpet-bombing the globe with industrial antibiotics. Suddenly, this accelerated the evolutionary battle into lightning chemical warfare.

In the process, something unheralded and alarming has been happening to the bacteria surrounding us, warns Timothy Walsh, the professor of medical microbiology and antimicrobial resistance at Cardiff University.

Under the onslaught of medical antibiotics, "the bacterias' structures have become unstable - sloppier and much more reactive to new bits of DNA about them", he says. "These microbes are responding to the environmental stress that our antibiotics create for them."

It is as though they are trying desperate gambits to retaliate. The most dangerous mutation to emerge so far sounds more like something from an episode of Doctor Who than a medical journal.

Professor Walsh explains that the latest bacterial tactic involves NDM-1. This is an enzyme - a mutant piece of DNA - that turns ordinary bacteria into lethal bugs which our best bullets bounce off.

The enzyme is spreading from one strain of bacteria to another, giving every new host the same drug-defying powers. NDM-1 originated in Asia. It is now swiftly colonising Britain and the rest of the Western world.

Public Health England says that the number of laboratory-confirmed cases of bacteria carrying NDM-1 has risen from just five in 2006, to more than 600 in 2013.

The bacteria known already to carry it include mutant versions of common and usually harmless gut bugs - Klebsiella and E.coli.

According to Public Health England, the NDM-1 enzyme has made them immune to our "last resort" antibiotics - called carbapenems - which medics use to beat infections when other antibiotics have failed.

NDM-1 breaks down these drugs, rendering them useless. It is also immune to most other antibiotics, including penicillins. Experts at the U.S. Centres for Disease Control say that it contributes to the death of up to half of patients who become infected.

Earlier this month, it was revealed that 16 people have died in the Central Manchester University Hospitals NHS trust area in the past four years after contracting one of these mutant strains - Klebsiella pneumoniae carbapenemase. Another died at Wolverhampton's New Cross Hospital.

Hundreds of other patients are believed to have been infected. Central Manchester says all the patients who died had been seriously ill with conditions such as diabetes, cancer, kidney problems or transplant rejection.

Professor Walsh is the man who first identified NDM-1, in 2000. He found it in samples from India. As is his habit, he named it after the city where it originated. It is called New Delhi metallo-B-lactamase 1.

This is one of the reasons that Walsh is barred from India. "Their government objected to what they see as an insult to their capital city," he says.

The other reason for the ban is that his work threatens one of India's rapidly growing profitable industries - medical tourism.

Every year, thousands of Britons travel there for cheap operations, often cosmetic surgery, but also organ transplants that NHS surgeons have declared too hazardous to perform. Hospitals on the subcontinent may charge only one-fifth of what a UK private hospital asks.

However, India effectively acts as a vast petri dish for growing new antibiotic-resistant superbugs. Poor sanitation and healthcare hygiene spread bacteria rapidly. Moreover, antibiotics can be bought cheaply, easily and frivolously at chemists on the subcontinent.

Professor Walsh says his recent study of 2,000 people in Karachi, Pakistan, has shown that 28 per cent carry E.coli with the NDM-1 DNA. From this, he estimates that across the whole subcontinent, 250 million people already harbour it.

"Many people travelling to India for operations must be contracting NDM-1 infections, says the professor. They then bring NDM-1 back to Britain.

"This combination of threats dwarfs the problem of British GPs over-prescribing antibiotics," he claims. He adds that, due to lack of surveillance, "no one has a clue how many people are bringing this into the UK or what the prevalence of NDM-1 is here."

A coroner's inquest in Swansea last year has highlighted one particularly tragic case involving medical tourism to India. The inquest heard how antibiotic-resistant E.coli killed a baby born 15 weeks premature whose mother had undergone IVF treatment in India.

The bacteria also killed the baby in the adjacent hospital incubator at Singleton Hospital, Swansea, who had been born 14 weeks premature.

The mother of the first child, named only as Baby A1, was unaware she had picked up the particularly deadly mutated form of E.coli, although it was mentioned in her medical notes from India. The inquest last July heard that the notes were not sent to staff in Swansea.

As a result, rigorous infection control procedures were not instituted and the infection passed to the second baby, Hope Erin Evans, from Aberdare, who also succumbed. She was only five days old.

NDM-1 is not going to go away, says Professor Walsh. "Once bacteria have the NDM-1 enzyme, they can't get rid of it without dying because it has become an essential part of their biology. They are held hostage by it," he explains.

Meanwhile, Britain is spearheading efforts to produce more powerful new antibiotics. Prime Minister David Cameron has launched a commission to tackle antibiotic resistance. Part of its remit is to create better incentives for the pharmaceutical industry and academic researchers to develop new drugs.

Professor Walsh fears this is naive. "There is no point producing new drugs if we don't have global patent safeguards to protect them from overuse," he says.

The answer, suggests Mark Lloyd Davies, the chair of the antibiotic network at the Association of British Pharmaceutical Industries, is to protect a new generation of antibiotics by stockpiling them in a secure place.

"There are already systems like this in place for drugs such as vaccines," he says. "Good stewardship of new antibiotics is absolutely the key by keeping them under strict Government control."

Certainly, if sense is to prevail, we must use far fewer antibiotics, in far more targeted ways. Even if we have to lock them away.

As in the era before antibiotics, hygiene must again become king. And patients must see the sense of leaving their GPs without a prescription in their pockets.

The alternative is no antibiotics at all - and a return to the days when a scratch from a rose can bring agonising death.

Read the article on the Daily Mail website

MRSA Action UK comments on reactions to the new NICE guideline on antimicrobial prescribing

derek butler

Wednesday 18 February 2015

GPs must help us do more to reduce superbugs, skills and training not cash incentives are needed

Derek Butler, Chair of MRSA Action UK appeared on ITN and Channel 5 News highlighting the need for GPs to focus on patient outcomes in the prescribing of antibiotics.

MRSA Action UK supported the development of the NICE guideline on the prevention and control of healthcare associated infections, and welcomed the introduction of the quality statement on the requirement of judicious antimicrobial prescribing.

As people who have been directly affected we welcome the opportunity to be stakeholders with NICE in developing the draft guidance. We would emphasise however, that the prescribing of antibiotics is, and will always be, the responsibility of the prescribing practitioner, whether that is in or outside of hospital. The guideline must be viewed as a minimum requirement, and colleagues should be encouraged to focus on judicious prescribing.

MRSA Action UK does not however support or agree with Professor Mark Baker's comment in the media that NICE is considering bringing antibiotics into the existing bonus scheme for GP's not to prescribe these drugs, this is both wrong and immoral as some patients will always require treatment for infections, it is the clinical need that needs to be ascertained and the correct diagnosis determined and appropriate treatment given that needs to be correct.

Making a decision about whether a respiratory illness is bacterial or viral is not always easy in someone who is more vulnerable. For example, some throat and ear infections are due to bacteria, and not viruses, and some people with a cough and breathlessness are actually developing pneumonia, which may be bacterial and antibiotics would be essential.

While tests such as throat swabs or sputum (mucus) samples can help with diagnosis, such investigations take time, so skill needs to be deployed to make these decisions. We would have to say that giving bonuses is not necessarily a prerequisite to a GP or any prescribers' ability to be able to do this. So financial incentives should not be the focus here, patient outcomes must always be the main focus of any prescriber; the need is for training and better information in this field of medicine.

We look forward to working with NICE.


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