31 January 2011
New guidance has been developed by the Health Protection Agency (HPA), in conjunction with the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI), to advise on the management of patients who are infected with bacteria resistant to carbapenem antibiotics.
Carbapenems are powerful broad-spectrum antibiotics that are often the last line of effective treatment for patients with infections - including hospital pneumonias, urinary infections or blood poisoning - caused by strains of the bacteria Klebsiella and E. coli that are already resistant to more widely used antibiotics.
The guidance, being issued to all consultant medical microbiologists and infection control specialists across the UK:
- advises how hospital laboratories can best detect carbapenem-resistant bacteria;
- stresses how the effective use of good infection control practices, such as screening and isolation of high risk patients, can help to contain the spread of infection;
- describes the few treatment options that do remain.
The geographical distribution and epidemiology of different types of carbapenem resistance is also outlined.
The guidance has been developed in response to enquiries from microbiologists and infection control specialists on the appropriate use of antibiotics following the identification of cases of infection with resistance to carbapenems, including those with the NDM-1 (New Delhi metallo) beta lactamase enzyme, which was described in a paper co-authored by the HPA and published in the Lancet Infectious Diseases in August 2010.
Aside from NDM-1 the HPA reports that other carbapenemases (enzymes that destroy carbapenems) are being seen in the UK, for example Verona Imipenemase (VIM), Klebsiella pneumoniae carbapenemase (KPC) and OXA-48.
Dr David Livermore, director of the HPA's antibiotic resistance monitoring and reference laboratory, said:
"It is critical, always, to understand how much of modern medicine - from gut surgery to transplants - depends on the ability to treat infection. If that ability is lost, through resistance, then medicine will take a great step backwards.
"The emergence of carbapenem resistance is a major public health concern and we hope this new guidance will help infection control specialists across this UK to better recognise, treat and prevent infections caused by bacteria with these resistances.
"This resistance makes infections much harder to treat. What's more NDM and the other enzymes that cause carbapenem resistance can be produced by many different types of bacteria, which can affect various body sites.
"The severity of the infections caused by bacteria with resistance to carbapenems varies. It depends on several factors including whether a patient has underlying medical conditions, his or her general health, and the site of the infection.
"The spread of antibiotic resistance underscores the need for good infection control in hospitals both in the UK and overseas, and highlights the need for new antibiotics to be developed.
"The World Health Organisation has recently emphasised the need for new antibiotics to be developed and for countries to take action to combat antimicrobial resistance, and this is a very welcome development."
The HPA conducts monitoring and surveillance on antibiotic resistance in the UK and has done so since the late 1980s. Surveillance is currently being undertaken for isolates that have been submitted to the HPA's Antibiotic Resistance Monitoring and Reference Laboratory and which were found to be carbapenemase-producers. The HPA also collaborates with pharmaceutical companies to undertake evaluations of new, developmental antibiotics against resistant bacteria, including those with carbapenemases.
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