Around 25,000 people die because of drug resistant infections every year across Europe, although this is known to be an underestimate based on poor data.
At its peak in the mid-2000s Clostridium Difficile killed over 6,000 people and MRSA killed more than 1,500. The government introduced targets to halve infection rates, and infection control measures brought in by hospitals reduced the numbers.
While these infections are now thought to be under control, infections from other types of resistant organisms are rising. Between 2010 and 2014 the rate of bloodstream infections caused by E. Coli and Klebsiella pneumoniae increased by 15.6% and 20.8% respectively. The government has now introduced a target to halve gram negative bloodstream infections by 2018.
Below are some of the most well-known superbugs (although the list is by no means exhaustive):
This is a superbug which occurs as a result of patients being given many courses of antibiotics or drugs over long periods of time. The drugs kill off all other bacteria in the gut, allowing the C difficile bugs to multiply and take over, causing an infection which can be lethal. Symptoms include severe diarrhoea and as the bug is resistant to antibiotics, it can be difficult to treat. Hospitals are required to report C difficile cases to the government.
Methicillin resistant staphylococcus aureus (MRSA)
This is a skin infection that has become resistant to antibiotics in the penicillin family normally used to treat it. It is found naturally on the skin and in the nose but can become deadly if it gets into the lungs or the bloodstream. It is found widely both in the community and in hospitals. In hospitals good infection prevention helps stop its spread.
Glycopeptide-resistant enterococci (GRE)
Enterococci are bacteria carried harmlessly in the gut, but a few species can cause infections if they get into the urinary tract, blood or into wounds. GRE infections are enterococci infections resistant to glycopeptide antibiotics such as vancomycin. GRE sufferers tend to be people with compromised immune systems, those who have been in hospital for a long time, or those who have previously been treated with antibiotics.
Multi-drug resistant pseudomonas aeruginosa
This is a bug that thrives in wet or moist places, and can be deadly as it is has developed resistance to multiple classes of antibiotics. It normally is only seen in people in hospitals or with weakened immune systems, but healthy people can develop ear and skin infections, especially if they come into contact with the bug after being exposed to contaminated water. In hospitals it can be spread on the hands of staff or on equipment that isn’t cleaned properly.
Multi-drug resistant acinetobacter
Acinetobacter bugs are found in soil and water, but can survive on people’s skin for several days. They might live on or in a patient without causing symptoms, but can go on to cause serious and deadly lung, blood or wound infections, especially in very ill patients being treated in intensive care. The rise of this bug is worrying as it is very effective at acquiring genes from other resistant bugs which make it resistant to antibiotics.
Drug resistant campylobacter
Campylobacter is the main cause of food poisoning in the UK, responsible for half a million infections, 100 deaths and 80,000 GP consultations every year. It is caught through eating contaminated milk, water or meat, especially chicken. In the UK, three quarters of supermarket chickens are known to carry campylobacter. After the last audit, the Food Standards Agency found 5% of samples of the bacteria – taken from chickens sold across the country – were resistant to many antibiotics.
Fluconazole-resistant xandida albicans
Candida albicans is a fungus, which is becoming resistant to the anti-fungal medicine fluconazole. Many people carry it without it doing any harm but it can cause infections in people with weakened immune systems.
These are bacteria, commonly gut bacteria such as Escherichia coli and Klebsiella pneumoniae which produce and enzyme that can break down two of the main classes of antibiotics. They are increasingly causing urinary tract infections which are more difficult to treat. They can also cause serious lung and bloodstream infections, which can be fatal. Genes giving bacteria the ability to make these ESBL enzymes can be transmitted between some bacteria.
These are gut bacteria which have acquired the ability to make enzymes which can break down certain antibiotics, such as penicillins and cephalosporins.
Carbapenem-resistant enterobacteriaceae (CRE)
Carbapenem-resistant Enterobacteriaceae are the more dangerous cousins of ESBL-producing enterobacteraciae. They are gut bacteria which have become resistant to carbapenem antibiotics as well as cephalosporins and penicillins. Some, known as CPE, create enzymes which break down these antibiotics, rendering them useless. While many people might carry CRE bacteria harmlessly in their gut, it can become a huge problem if it spreads in hospitals where patients have compromised immune systems. If an infection occurs, doctors have few drugs left to treat it. CRE have been dubbed ‘nightmare bacteria’ by the US Center for Disease Control and Prevention as between 40% and 50% of people with a bloodstream infection die, studies show.
Drug resistant non-typhoidal salmonella
This is a bacteria that commonly causes food poisoning. It becomes more dangerous when it is resistant to antibiotics.
Drug resistant salmonella typhi/paratyphi
There is now an epidemic of drug resistant typhoid fever is the Indian subcontinent, Asia and Africa, with an estimated 10 to 30 million cases a year. It is spread through contaminated food and water.
Drug resistant shigella
Shigella is a highly contagious bacteria that can cause diarrhoea with blood or mucus, which is becoming resistant to antibiotics. It is spread by contact with infected food or water, while travelling or between people in hospitals or care homes for long periods. It causes more than a million deaths worldwide a year, mainly in children in developing countries. In the UK, most cases are acquired in people who have travelled but it can also spread from child to child at home or in nurseries. Some species are more common among gay and bisexual men.
Drug resistant tuberculosis
Tuberculosis is a disease caused by bacteria spread from person to person through the air. It usually affects the lungs but can also affect the brain, kidneys or spine. It is curable if treated, but the emergence of drug resistant TB is worrying as it is much harder, and more expensive, to treat. There are multi-drug-resistant TB (MD TB) which is resistant to the two most potent TB drugs. Extensively drug-resistant TB (XDR TB) describes bacteria which has become resistant to a wider range of antibiotics, meaning patients are left with less effective treatment options. Patients with XDR TB are much more likely to develop disease and have a higher risk of death.
Drug resistant gonnorrhoea
Gonnorrhoea is a a sexually transmitted infection which is normally treated with the antibiotic azithromycin. Now the bacteria are becoming resistant to this drug, meaning there is only one other drug, ceftriaxone, which can be used to treat it. This raises the prospect of it becoming untreatable if the bacteria becomes resistant to ceftriaxone. There is an outbreak of this resistant strain in the UK, with 48 confirmed cases between November 2014 and August 2016.