Rise in 'last-resort' antibiotics prescribed by hospitals


Hospitals are increasingly turning to "last-resort" antibiotics as the number of drug-resistant infections continues to rise.

A new report from Public Health England (PHE) shows more people suffered a "significant antibiotic-resistant infection" - both in hospitals and the community - between 2010 and 2014.

Rates of bloodstream infections caused by Escherichia coli (E. coli) jumped 15.6% and Klebsiella pneumoniae increased by 20.8% from 2010 to 2014.

E. coli can cause severe stomach cramps, vomiting and diarrhoea that may be bloody, and in serious cases can lead to kidney failure and death.

Klebsiella pneumoniae causes urinary tract infections and pneumonia but can also lead to blood poisoning.

The report said that while overall resistance to key antibiotics used to treat infections has remained constant in E. coli, the fact there are more bloodstream infections means more people have suffered a significant antibiotic-resistant infection.

It added: "Increases in Klebsiella pneumoniae bloodstream infections and the proportion of these infections which were drug resistant means the number of individuals with antibiotic resistance infections have increased substantially in the last five years."

Most antibiotics are prescribed in GP surgeries (74%) while hospitals account for 18% of all antibiotic prescribing.

Hospitals use more broad-spectrum antibiotics, which are effective against a wide range of bacteria.

The report showed that the use of broad-spectrum antibiotics rose significantly between 2010 and 2014.

The use of carbapenems and piperacillin/tazobactam - regarded as "last-resort" antibiotics - increased by 36% and 55%, respectively, over the period, although the rate of increase is slowing.

Overall, prescribing to hospital inpatients increased "significantly" by 11.7% and to hospital outpatients by 8.5% between 2011 and 2014.

There is a worldwide drive to cut the number of antibiotics prescribed because their use is pushing up antibiotic resistance.

The report showed there has been a rise in the overall consumption of antibiotics via GP surgeries, although the actual number of prescriptions is falling.

Between 2011 and 2014, there was a 6.5% rise in total antibiotic consumption (defined as doses of antibiotics per 1,000 people per day).

"This suggests that longer courses and/or higher doses of antibiotics are being prescribed in general practice," the study said.

But use of broad-spectrum antibiotics has fallen in GP surgeries to 8.5%.

For some bacteria, there have also been good results in cutting infections.

Streptococcus pneumoniae bloodstream infections fell by 23% between 2010 and 2014, which may be related to increased pneumococcal vaccination rates.

Dr Jonathan Pearce, head of infections and immunity at the Medical Research Council, said: "This report reinforces the need for real solutions for antibiotic resistance - it's a growing problem and it's right on our doorstep.

"In fact, if you laid all the unnecessary prescriptions for antibiotics on top of each other, just for England alone, the paper tower would be double the size of the Empire State Building or 10 times the height of Big Ben."

Dr Mike Durkin, NHS England's director of patient safety, said: "As one of the largest healthcare providers in the world, it is vital the NHS is seen to lead that fight against the global problem of antimicrobial resistance so these immensely important medicines can be preserved for now and future generations."

Dr Maureen Baker, chair of the Royal College of GPs, said: "Rising resistance to antibiotics is now a global threat and the implications of this must not be underestimated.

"As doctors - and patients - we all have a responsibility to reduce the amount of antibiotics prescribed and taken."