Dr Graeme JonesDoctors and nurses in Southampton have launched a drive on antibiotic prescribing and hand hygiene among clinicians, patients and visitors in a bid to halt the spread of a new antibiotic-resistant infection.
Dr Graeme Jones, director of the infection prevention unit at University Hospital Southampton NHS Foundation Trust, said a lack of adequate hand hygiene and the over-prescribing of antibiotics for mild infections was creating a “breeding ground” for new and hard to treat bugs.
He spoke out after a recent routine infection screening exercise at Southampton General Hospital unexpectedly found three patients tested positive for Klebsiella pneumoniae producing carbapenemase (KPC). Although they do not currently have any clinical infections, the patients are in isolation and receiving appropriate treatment.
The bacterium, which was not previously part of routine screening due to its low prevalence, is carried harmlessly in the gut of all humans and animals but, if it enters a wound or spreads into the urinary tract or bloodstream, can cause serious infection.
KPC is part of a group of bacteria – known as carbapenemase-producing Enterobacteriaceae – that has developed the ability to destroy strong antibiotics called carbapenems, which are often used by doctors as a last resort to treat complicated infections when other antibiotics would or have failed.
Although it is treatable, it is more difficult and may require a combination of drugs or the use of older antibiotics to be effective.
“Antibiotic prescribing in hospital is complicated, particularly when dealing with patients who have serious underlying illness and any infection can be a major setback to their recovery,” explained Dr Jones, a consultant microbiologist.
“The difficulty is that overtreatment with a more powerful antibiotic than is actually needed encourages the development and spread of antibiotic-resistant bacteria and that is something we are seeing more and more of.”
He added: “This, in addition to poor hand hygiene, creates a real breeding ground for new and very tough strains of infection to develop, which is what we’re seeing gradually creep into hospitals across the country at the moment.”
In England, approximately two thirds of trusts have had between one and 20 patients identified with similar infections over the past five years, including two trusts in Manchester that have had more than 100 patients during the same period.
A screening programme is currently under way at Southampton General for a small group of patients who came into contact with those carrying KPC before they were moved to isolation.
Dr Jones said: “Unfortunately this type of infection is on the rise, but we hope to have limited its transmission on this occasion by acting quickly to move patients and undertake a screening programme.
“However, what this discovery tells us is that this problem is not going to disappear and emphasises the need for us all – both clinically and via our patients and visitors – to focus attention on taking stringent infection prevention action to limit risk.
“Doctors need to be very clear about which antibiotics they use to treat infection and why, but one thing we can apply to everyone is the need for improvement in attitudes towards hand hygiene.”
Posted on Tuesday 18 March 2014