23.03.17 Antibiotic Resistance

A deadly superbug is silently spreading through UK hospitals

Lying in a hospital bed, four months pregnant, Emily Morris felt only terror. She had caught a urinary tract infection and it was resistant to common antibiotics. Doctors needed to treat it as it could harm the baby, but the only drugs that could work hadn’t been tested on pregnant women before; the risks were unknown. Overwhelmed, Emily and her husband were asked to make a decision. A few hours later, gripping each other’s arms, they decided she should be given the drugs.

In Emily’s case, the medicine worked and her son Emerson was born healthy. But rising antibiotic resistance means people are now suffering infections for which there is no cure. Doctors have long warned that decades of reliance on these drugs will lead to a ‘post-antibiotic era’– a return to time where a scratch could kill and common operations are too risky.

It sounds like hyperbole – but this is already a reality in the UK. In the last four years 25 patients have suffered infections immune to all the antibiotics Public Health England tests for in its central lab, the Bureau of Investigative Journalism has discovered.

Emily Morris, 24, got infected with a resistant form of E.coli while pregnant

Some of these deaths were caused by one of the world's most deadly superbugs - a group of bacteria known as carbapenem-resistant enterobacteriaceae (CRE). While CRE cases are rare, reports are rising, and infection control doctors are worried. 

CRE can live harmlessly in the human gut but if they get into the wrong place, like the urinary tract or a wound, they can cause infections. They have evolved to become immune to most classes of antibiotics – so if someone does become infected, there are only a few drugs that can work. If CRE bacteria get into the bloodstream, studies show between 40% and 50% of people die.

These bugs are causing huge problems in India, certain parts of Asia, the middle east and some countries in southern Europe. Until recently, most infections were seen in people who had travelled abroad; had family members who had; or had been in a foreign hospital. The boom in cheap cosmetic surgery in India was blamed for a spate of infections in Britain.

Now, doctors are finding people who have never boarded a plane are carrying the bug. There have already been outbreaks in Manchester, London, Liverpool, Leeds, Edinburgh, Birmingham, Nottingham, Belfast, Dublin and Limerick among other areas. Patients found with CRE have to be treated in side rooms in hospital so the bacteria does not spread and harm other vulnerable patients. But in many of Britain’s Victorian-built hospitals, single rooms are in sparse supply. Deaths from CRE aren’t centrally recorded by the government - but it is thought hundreds have already died.

Across the country, doctors are being forced to reach for older, more toxic drugs to treat these infections. Doses of a drug called colistin – known as the ‘last hope’ antibiotic as it is one of few treatment options still effective against CRE infections - rose dramatically in English hospitals between 2014 and 2015, the Bureau has revealed. Colistin was first introduced in the 1950s but taken off the shelves soon after as it can harm the kidneys and nervous system in high doses. It has been reintroduced in recent years after infections became immune to standard treatment. 

However the more we use colistin the more bacteria develop resistance to it. It’s only a matter of time before it stops working too, leaving doctors’ arsenals near-empty when it comes to the most dangerous superbug infections.

Due to a kidney problem, Emily Morris suffers repeat urinary tract infections and has to be hospitalised most months. Her son Emerson comes to visit her, understanding his mummy is ill. If she catches a superbug infection, she can still be given intravenous antibiotics to stem it. But she worries about her son. By the time he is an adult, if he gets ill, there may be no drugs left that work.

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