An upsurge in cases of a highly-resilient superbug at Homerton Hospital is part of a “worrying” rise in resistance to the world’s most potent antibiotics, a leading microbiologist has warned.
Carbapenemase-producing Enterobacteriaceae (CPE) is impervious to carbapenems, a class of antibiotics described as “the drugs you go to when all else has failed”, making the bug almost impossible to treat.
Records obtained by the Hackney Citizen under the Freedom of Information Act show CPE infections have steadily risen at Homerton Hospital from just a single case in 2013/14 to eleven in 2016/17.
According to Professor Sally J. Cutler, a microbiologist at the University of East London, Homerton’s numbers are relatively low compared to other hospitals, but are still part of an “alarming” global trend.
She said: “Microbiologists have been talking about this for over 20 years. Carbapenems are a group of powerful, last resort antibiotics which are reserved for severe infections. They are the drugs you go to when all else has failed. But the rise in CPE infections shows resistance to even these antibiotics is spreading rapidly.”
According to Public Health England, the number of confirmed cases of CPE surged from just three to almost 2,000 in the 12 years leading up to 2015.
Cutler added: “We’ve always relied on antibiotics to help us recover from infections and not die. The scary reality is – how much longer can we go by this belief? Resistance is growing in many other antibiotics, and now we’re seeing resistance in the last resort ones as well, which is very alarming.”
She says part of the problem is a tendency among doctors and vets to think of individual patients, rather than the population as a whole, which has led to them over-prescribing carbapenems.
But she sympathised with care-givers, acknowledging the “enormous pressure” they are under: “When you are faced with a profoundly sick patient, you want to make them better straight away.”
Another issue is patients’ increasing demand for treatment. Some people carry CPE harmlessly without becoming infected, Cutler says, but should a patient be alerted to that fact, they may feel “shortchanged” if they’re not given a pill to swallow.
“Clinicians have to do whatever they can, and sometimes that means they go for the fallback option immediately. If they fail to do so, they might also be subject to litigation further down the line.”
When asked why experts have been ignored for so long, Cutler was decisive: “Money. These antibiotics are big business. When someone says we need to stop prescribing them, or at least limit their use, companies do not want to listen.
“This rise in resistance is a monster we have created ourselves.”
To help tackle the problem, she called for the introduction of a “hierarchy” model for treating patients, telling doctors: “Don’t go for the silver bullet straight away. Try something else and if that doesn’t work, then consider more powerful antibiotics.”
Cutler did praise Homerton for reporting its CPE figures – something that is not yet mandatory – and said that its relatively low number of infections shows the hospital is “clearly doing a good job of picking them up”.
Commenting on the numbers, a spokesman for Homerton Hospital said: “There has been both a national and regional increase in the number of CPE infections since 2013/14. The majority of our CPE cases are in patients repatriated from other hospitals and the increasing number of infections reflects the regional picture.”
He confirmed that none of the infected patients had died, and added: “The hospital has put in place a policy based on the national guidance for the prevention of CPE. I believe we have the lowest numbers of CPE infections compared to other hospitals in this part of London.”/ 16 May, 2017