Tag Archives: c diff

Superbug dangers

Drug-resistant “superbugs” represent one of the gravest threats in the history of medicine, leading experts have warned.

Routine operations could become deadly “in the very near future” as bacteria evolve to resist the drugs we use to combat them. This process could erase a century of medical advances, say government doctors in a special editorial in The Lancet health journal.

Although the looming threat of antibiotic, or anti-microbial, resistance has been known about for years, the new warning reflects growing concern that the NHS and other national health systems, already under pressure from ageing populations, will struggle to cope with the rising cost of caring for people in the “post-antibiotic era”.

In a stark reflection of the seriousness of the threat, England’s deputy chief medical officer, Professor John Watson, said: “I am concerned that in 20 years, if I go into hospital for a hip replacement, I could get an infection leading to major complications and possible death, simply because antibiotics no longer work as they do now.”

About 35 million antibiotics are prescribed by GPs in England every year. The more the drugs circulate, the more bacteria are able to evolve to resist them. In the past, drug development kept pace with evolving microbes, with a constant production line of new classes of antibiotics. But the drugs have ceased to be profitable and a new class has not been created since 1987.

Writing in The Lancet, experts, including England’s chief medical officer, Dame Sally Davies, warn that death rates from bacterial infections “might return to those of the early 20th century”. They write: “Rarely has modern medicine faced such a grave threat. Without antibiotics, treatments from minor surgery to major transplants could become impossible, and health-care costs are likely to spiral as we resort to newer, more expensive antibiotics and sustain longer hospital admissions.”

Strategies to combat the rise in resistance include cutting the amount of antibiotics prescribed, improving hospital hygiene and incentivising the pharmaceutical industry to work on novel antibiotics and antibiotic alternatives.

However, a leading GP told The Independent on Sunday that the time had come for the general public to take responsibility. “The change needs to come in patient expectation. We need public education: that not every ill needs a pill,” said Dr Peter Swinyard, chairman of the Family Doctor Association.

“We try hard not to prescribe, but it’s difficult in practice. The patient will be dissatisfied with your consultation, and is likely to vote with their feet, register somewhere else or go to the walk-in centre and get antibiotics from the nurse.

“But if we go into a post-antibiotic phase, we may find that people with pneumonia will not be treatable with an antibiotic, and will die, whereas at the moment they would live.

“People need to realise the link. If you treat little Johnny’s ear infection with antibiotics, his mummy may end up dying of pneumonia. It’s stark and it’s, of course, not direct, but on a population-wide level, that’s the kind of link we’re talking about.”

Antibiotics

Antibiotics

There are no reliable estimates of what resistance could cost health systems in the future, but the European Centre for Disease Prevention and Control believes that €1.5bn (£1.2bn) a year is already being spent on health problems associated with antibiotic resistance in Europe.

Joanna Coast, professor of health economics at the University of Birmingham, said that the problem of resistance had the potential to “affect how entire health systems work”.


Professor Coast added: “We don’t know how big this is going to be. It’s like the problems with planning for global warming. We know what the costs are now but we don’t know what the costs will be into the future.

“Much of what we do in modern health system relies on us having antibiotics. We need them for prophylaxis for surgery, for people having chemotherapy for cancer. The worry is that it might make big changes to how we run our health system.”

Antibiotics are also used in vast quantities in agriculture, fisheries and by vets, the resulting environmental exposure adding to bacterial resistance, with further consequences for human health.

Experts say that to meet demand without increasing resistance, drug companies will need to find new ways of financing antibiotic development that are not linked to expectations of large volume sales. Global health authorities such as the World Health Organisation have also warned that global drives to reduce antibiotic use must not harm access to life-saving drugs in poorer countries.

Writing in The Lancet, Professor Otto Cars of Uppsala University in Sweden, and one of the world’s leading experts on antibiotic resistance, said: “Antibiotic resistance is a complex ecological problem which doesn’t just affect people, but is also intimately connected with agriculture and the environment.

“We need to move on from ‘blaming and shaming’ among the many stakeholders who have all contributed to the problem, towards concrete political action and commitment to address this threat.”

C. difficile vaccine

A vaccine has been developed that could wipe out almost all cases of the killer superbug C diff in hospitals.

At present there are more than 15,000 cases of the disease a year, causing 1,500 deaths mainly in hospitals, but also in care homes for the elderly.

At its peak four years ago there were more than 80,000 cases and 6,000 deaths annually.

The disease is easily spread by hand and easily takes hold in patients who have become resistant to antibiotics.

Improved infection control methods have driven down cases, although NHS cuts have been blamed for a rise in some areas of the country.

The vaccine, which has reached final phase three trials, is to be tested on 1,800 UK patients at nine hospitals as part of 15,000 strong world trial by the drug company Sanofi-Pasteur.

Earlier trials of the C diff vaccine have shown to be safe and effective against the stomach superbug and there are hopes that it could become available in as little as three years.

The aim would be to vaccinate those most at risk – normally the elderly and those with weakened immune systems – before they enter hospital for routine treatment or surgery.

Sanofi-Pasteur has spent more than a decade developing the vaccine and company officials are confident it will get a license.

Dr Tom Blanchard, an infectious diseases consultant at North Manchester Hospital, who is heading the UK trial, said: “This is very exciting as this will be the first vaccine to fight a hospital superbug.

“By vaccinating the most vulnerable we should be able to deliver a major blow to the number of cases we are still seeing.

“We have got the number of cases right down but we are conscious that a strain that doesn’t respond to antibiotics could appear that would lead knock us back. The reason why we had such a large rise in the early 2000s was because of very virulent form of the infection.”

At present there are only a handful of anti-biotics that work against the toxins that cause the terrible diarrhoea suffered by patients. Despite these drugs as many as 20 per cent of patients thought to have been successfully treated suffer a recurrence.

Besides a 10 per cent death toll, the disease causes a huge financial burden on the NHS with patients having to sometimes be put in expensive isolation and taking up beds needed by other patients.

Clostridium difficile

Clostridium difficile

Outbreaks can require war closures for ‘deep cleans’ to eliminate the bug.

One of the most notorious outbreaks was at Maidstone Hospital where hundreds of patients were infected and almost one hundred died over a three-year period

The Healthcare Commission concluded that the superbug caused 90 deaths and was a contributory factor in a further 255 in two-and-a-half years.


The chief executive resigned for failing to take action when it became clear there was an outbreak.

At Stoke Mandeville Hospital in Buckinghamshire, 334 patients were infected and 33 died.

Hospital infections were already causing alarm thanks to the rise of MRSA. But no one had heard of C. diff before the Stoke Mandeville outbreak in 2005 catapulted the issue of hospital infections up the political agenda.

Patients taking part in the Sanofi trial will have a course of three vaccinations which is hoped will give them life-time protection against infection in case they are admitted to hospital again.

Dr Blanchard added: “I don’t think we will have any difficulty recruiting patients if we tell them they are getting a vaccine that is likely to prevent them getting C diff.

“This is likely to be a very popular vaccine if it gets approved.”