Bugs resistant to ‘last resort’ antibiotics on rise

The letter warns that cases of organisms resistant to carbapenems antibiotics usually of last resort have increased in Scotland. Picture: TSPL

In a letter to health boards, Chief Medical Officer Sir Harry Burns and Chief Nursing Officer Ros Moore warn that cases of organisms resistant to carbapenems – antibiotics usually of last resort – have increased in Scotland in recent years.

These drugs are vital because they are frequently used to treat the most severely ill patients where other antibiotics have failed. But figures show that there have been 79 reports of patients carrying a bug resistant to carbapenems in Scotland since 2003 – the majority in the last three years. Last year, 25 of these resistant organisms – known as carbapenemase-producing Enterobacteriaceae (CPEs) – were reported in Scotland, up from 20 in 2010 and 13 in 2011. In 2007, only one such case was reported.

In the letter, the medical leaders warned that since they first raised concerns about carbapenem resistance in November 2010, there had been “extensive spread” of the cases in a number of European countries, including more than 70 health trusts in England reporting cases so far.

The officials warned the risk of a patient carrying a resistant bug remained highest in those who had been in hospital outside Scotland. “The risk is greatest in patients who have received prolonged hospital care and attended specialist units abroad,” they wrote.

Countries with high rates of CPE include Greece, Italy, India and the US. But the letter warned that many cases may not be detected or reported “resulting in underestimation of the true extent of CPE occurrence in Europe”.

The medical leaders said hospitals should have systems in place to rapidly identify patients who have been in hospital abroad or tested positive for CPE. “These patients should be immediately isolated and advice taken from the infection control team,” they said.

Dr Camilla Wiuff, a consultant at Health Protection Scotland, said carbapenems were a key group of antibiotics because they could treat complicated infections.

“They are very useful in severely ill patients. So we don’t want to push the development of resistance towards this group of antibiotics because it is one of the most valuable available,” Dr Wiuff said.

A Scottish Government spokesman said: “Anti-microbial resistance and healthcare-associated infection are key priorities for the Scottish Government and NHS Scotland. Anti-microbial resistance is a worldwide issue and we are currently working with other administrations to improve clinical practice and ensure more effective treatment and control.”