“Antibiotics: ‘national threat’ from steep rise in patients who are resistant to drugs,” The Daily Telegraph reports. The Mail Online reports that there were, “600 reported cases of drugs failing because of resistant bacteria last year”.
What isn’t made very clear is that these 600 cases were of one very specific form of antibiotic-resistant bacteria called carbapenemase-producing Enterobacteriaceae (CPE).
Enterobacteriaceae is a large group of types of bacteria. The group includes harmless bacteria that live in the gut, as well as bacteria such as E. coli, and Salmonella that can cause food poisoning. Enterobacteriaceae can also cause infection if they enter the wrong part of the body, such as the blood stream.
Some of these bacteria have developed resistance against a group of strong antibiotics called carbapenems, which are normally used to treat the most serious infections.
The resistant CPE bacteria produce an enzyme (carbapenemase) that breaks down the antibiotic and makes it ineffective.
This is potentially serious as carbapenems are essentially a weapon of last resort in our “antibiotic armoury”. If carbapenem resistance became widespread then the consequences for public health could be akin to a return to the pre-antibiotic era.
To address the concern, Public Health England has released a “toolkit” – a series of recommendations to help health staff limit the spread of CPE in hospitals.
A world without antibiotics
A world where antibiotics became ineffective would not be a pleasant one. Infections such as scarlet fever and tuberculosis could lead to the sort of mortality rates not seen since the early 20th century.
Also, medical procedures that we currently regard as safe, such as routine surgery and even dentistry, would be carried out with an increased risk from infection. More complex procedures such as organ transplants could become untenable due to the increased infection risk.
What is antibiotic resistance?
Antibiotics are drugs used to treat infections caused by bacteria. Sometimes bacteria develop the ability to survive antibiotic treatment, this is called antibiotic resistance.
When a strain of bacteria become resistant to an antibiotic it means this antibiotic will no longer be effective for treating the infections they cause. Antibiotic resistance is one of the most significant threats to patient safety in Europe. Read more about antibiotic resistance.
What are CPE bacteria?
Carbapenemase-producing Enterobacteriaceae are bacteria that live in the gut and are normally harmless. However, if they get into other parts of the body, such as the bladder or bloodstream, they can cause an infection.
Carbapenems are strong antibiotics similar to penicillin. They are used by doctors as a ‘last resort’ to treat some infections when other antibiotics have failed. Some Enterobacteriaceae make enzymes called carbapenemases that allow them to break down these antibiotics, and this makes them resistant. Only a few strains of Enterobacteriaceae produce carbapenemases currently, but this number is growing.
What does the CPE public health toolkit aim to do?
Public Health England’s advice for healthcare professionals in England focuses on early detection of CPE, as well as advice on how to manage or treat CPE, and control their spread in hospitals and residential care homes.
Public Health England has produced information leaflets for healthcare professionals to give to people who have been identified as being carriers or infected with CPE, or who are in contact with people who are infected.
Why do we need help managing these antibiotic-resistant bacteria?
There are currently only a few strains of carbapenemase-producing Enterobacteriaceae (CPE), but this number is growing. In 2006, there were five patients reported to Public Health England as having CPE, but by 2013 this number had risen to more than 600. These numbers include people who were just carriers of CPE, as well as those with infections.
Public Health England wants to act quickly to minimise the spread of CPE, as rapid spread could mean doctors are less able to rely on carbapenem antibiotics. This could pose an increasing threat to public health.
What information does Public Health England offer patients?
Public Health England’s CPE toolkit explains what CPE are, and the importance of carbapenem resistance. It explains that:
- there is an increased chance of picking up CPE if you have been a patient in a hospital abroad or in a UK hospital that has had patients carrying the bacteria, or if you have been in contact with a CPE carrier elsewhere
- if a doctor or nurse suspects that you are a CPE carrier, they will arrange for screening to see if you are a carrier
- screening usually involves taking a rectal swab or giving a sample of faeces
- while a patient is waiting for the screening result, and if they are found to have CPE, they will be kept in a single room with its own toilet facilities. This is to limit the potential for spread of CPE to other people through contaminated faeces
- the most important way for a patient and visitors to reduce spread of CPE is to regularly wash hands well with soap and water, especially after going to the toilet
- patients who have a CPE infection need to be treated with antibiotics, but those who just carry CPE in their gut do not need antibiotics