The frequent appearance of Clostridium difficile in hospitals around the world is tracked by countries using different methods. C-difficile is seen as a serious health issue due to its quick rise in the number of cases reported worldwide. C-difficile is one of the superbugs for which there are no known antibiotics that can be used as treatment. There are other superbugs that have come into existence, such as the Klebsiella pneumonia, and Delhi metallo-beta-lactamase (NDM-1), a superbug from India, all which have appeared due to the overuse and over-prescription of antibiotics in recent times. This article appeared on the Reuters website health pages.
Studies show drug-resistant bug threats in Europe
Drug-resistant infections with the “superbug” Clostridium difficile are rising in Europe and are widespread, scientists said on Tuesday, but there are big variations in the way health authorities monitor them.
In a Europe-wide study, researchers found the incidence of C-difficile infections in hospitals had risen to 4.1 per 10,000 patient days in 2008 from 2.45 per 10,000 patient days in 2005.
“It is clearly on the increase, that’s for sure,” said Ed Kuijper of Leiden University Medical Centre in The Netherlands, who led the study with his colleague Martijn Bauer.
“There is also a huge variation of incidence in different European countries — mainly due to the fact that each country uses its own surveillance system and its own diagnostic tests, so in some countries it is underestimated and in other countries it is overestimated.”
Overuse and misuse of antibiotics in recent decades have fuelled a rise in drug-resistant “superbug” infections like C-difficile, a bacterial infection in the gut, and methicillin-resistant Staphyloccus aureus (MRSA). [ID:nL6407857]
Earlier this year, scientists warned that a new so-called superbug from India known as New Delhi metallo-beta-lactamase (NDM-1) could spread around the world. [ID:nLDE67A0O1]
The European Centre for Disease Prevention and Control (ECDC) said that up to 400,000 patients in the region suffer multi-drug resistant infections and antibiotic resistance remains a major public health problem.
“SERIOUS THREAT”
Launching a campaign to increase awareness of antibiotic overuse, the ECDC highlighted a particular bug called Klebsiella pneumoniae, a common cause of infection amongst hospital patients, which like NDM-1 is becoming increasingly resistant to powerful last-line antibiotics such as carbapenems.
“Antibiotic resistance remains a serious threat to patient safety, reducing options for treatment and increasing lengths of hospital stay, as well as patient morbidity and mortality,” said ECDC director Marc Sprenger.
GPs are writing prescriptions for the latest, most expensive antibiotics – ignoring cheaper and better options, say
researchers. The British Pharmaceutical Conference heard one in eight prescriptions in one area were for more modern drugs, often breaching guidelines. Experts say these drugs should be held back as a “last line of defence” – to cut the risk of bacterial resistance.
Doctors’ leaders said there might be good reasons for GPs’ choices. Doctors in both hospitals and GP surgeries are under great pressure to curb their antibiotic use, as over-use can lead to the development of “superbugs” resistant to all but a few modern drugs.
In recent years, new classes of powerful antibiotics have been developed to counter this threat, and guidelines say these should be used sparingly and only on certain conditions and where earlier antibiotics have failed.
Four out of five prescriptions for antibiotics are written in the GP surgery, and a team from Liverpool John Moores University wanted to check what they were using and how often. They looked at computer records and found that 15% of all antibiotic prescriptions were for more modern, expensive drugs, and that guidelines designed to restrict their use were not being followed.
The problem with guidelines is that none of them perfectly fits every situation Dr Jim Kennedy, RCGP. “The risks associated with this behaviour are that the drug may be unnecessary or inappropriate, increasing the potential of
resistance and increasing costs to the primary care trust.”
Dr Jim Kennedy, the Royal College of GPs Head of Prescribing, said that a more detailed picture of prescribing would be needed to identify a problem. “We don’t know if this is a couple of rogue prescribers, or whether there were good reasons why the guidelines weren’t being followed. “The problem with guidelines is that none of them perfectly fits every situation.”
He said that it was possible that the overall downward trend in antibiotic prescribing in recent years might mean that the appropriate use of stronger, modern antibiotics appeared to increase, as GPs continued to use these appropriately in the treatment of more serious bacterial infections. Hospital overdose Another study presented to the conference in Manchester highlighted the difficulties faced by those trying to curb overuse of antibiotics – this time within hospitals.
We think that doctors are still being overcautious about the risk of hospital acquired infections Dr Rachel Etherington, Sunderland University RCGP Many patients undergoing surgery are given a handful of doses of antibiotics to cut their chances of developing an infection, but Sunderland University researchers found in 2005 that more than half were getting too many in nearby City Hospitals Sunderland.
One woman patient was reportedly given 81 doses of antibiotics rather than the three to five required. The trust changed its electronic prescribing system so that doctors would have to write in a date past which no antibiotics would be given. However, the conference was told that the result was that 74% of patients received too much antibiotic, rather than 55% before the change, as doctors allowed for too many days of treatment.
Lead researcher Dr Rachel Etherington: “We think that doctors are still being overcautious about the risk of hospital acquired infections – perhaps partly due to media coverage of ‘superbugs’.”
News Source: BBC News
