Warning over hospital superbug linked to 16 deaths

Nationwide research is being carried out into Klebsiella and its resistance to antibiotics

Sixteen people have died in Manchester in the past four years while infected with a highly resistant superbug, figures show.

Klebsiella pneumoniae carbapenemase (KPC) is causing increasing concern and a rising number of cases.

Some 1,241 patients were affected within the Central Manchester University Hospitals trust area from 2009 to 2013, the figures show.

Despite infection control, the numbers have increased year on year.

The figures, revealed in a Freedom of Information request by the BBC, found 62 patients so far have suffered blood poisoning - with 14 confirmed deaths within 30 days of infection - at Central Manchester University Hospitals NHS Foundation Trust.

Two further deaths have occurred in the current year, the hospital trust confirmed.

KPC, which causes urinary tract infections and pneumonia in sick patients, is resistant to carbapenems, the last major group of antibiotics to work against multidrug-resistant bacteria.

The trust said the chemical, an enzyme, that KPC uses to render antibiotics ineffective had now entered other bacteria, including E. coli and Enterobacter.

"This trust has and continues to make strenuous efforts to control and reduce this infection. We continue to work very closely with Public Health England at both a local and national level to develop solutions for the long-term management of patients," it said.

The trust stated that all the patients who had died were seriously ill. Some had diabetes, kidney problems or transplant rejection; some were suffering from leukaemia or other forms of cancer.

Central Manchester Hospitals has already had to review guidelines on antibiotics and the treatment of patients who require bowel surgery or cancer treatment that may leave their immunity compromised.

'Extremely unlucky'

Another Manchester hospital, the Christie, a specialist in cancer care, said nine patients had been colonised by KPC last year. but they had all been transferred to the cancer unit and there had been no cross-infection in the hospital.

A Freedom of Information request has also revealed two cases of KPC at New Cross Hospital in Wolverhampton, with one patient dying in the past two years.

Microbiologist Dr Mike Cooper said that the patient who died was 96 and the form of KPC that had infected her was still susceptible to some drugs.

"There's a huge element of luck in this. Either Manchester has been extremely unlucky or we have been extremely lucky not to have more cases," he said.

Ten patients have also been infected at the University Hospital of North Staffordshire. Two had urinary tract infections, but neither patient died of blood poisoning.

Stoke's microbiologist, Jeorge Orendi, said: "Unlike the situation in certain hospitals in Manchester and London, fortunately in our hospital and catchment area carbapenemase producers have remained rare to date."

The KPC resistance mechanism first emerged in the US and spread to Israel. In Europe, it has taken hold in Greece and has reached epidemic proportions in Italy.

Gian Maria Rossolini, of the University of Siena, said that the first case was identified in Italy in 2008, but now 4% of all infections in Italy are resistant to carbapenems.

Aids epidemic

Dr Rossolini said deaths from blood infections were running at more than 40%, but for immune-compromised patients they could be as high as 80%.

Although KPC is still susceptible to an old and quite toxic antibiotic, colistin, in Florence this year more than 50% of KPC cases proved resistant to it.

"Although present in the UK, the problem seems to be still much more limited as compared to Italy and Greece," he said.

Professor Laura Piddock, of Birmingham University, said: "It's clear that what has gone on in Italy is our tomorrow. We have got to start preserving what we have got and use it wisely.

"If we are really serious about tackling this problem, we have to start viewing this in the same way as high-income countries viewed the Aids epidemic in the 90s.

Prof Peter Hawkey is mapping the spread of KPC across the country

"It's going to take that sort of level of global policymaker decision-making to really tackle this issue properly."

Research published in the Journal of Antibiotics found that colonisation with KPC is long-lasting, with 39% of patients still carrying KPC in their gut a year after being released from hospital.

In Birmingham, Prof Peter Hawkey is conducting nationwide research to identify the extent of KPC resistance and that of a more widespread, but slightly less virulent superbug, ESBL.

Patients in London, Southampton, Birmingham and Shropshire are being asked to send in faeces samples so the spread of the disease can be mapped.

Prof Hawkey said: "It makes sense whilst we are looking for these ESBL that we are also able to detect how many of these KPC organisms are in the community.

"I can conceive of techniques which may be able to make bacteria to kill these multidrug-resistant bacteria. It's very much at an advanced research level at the moment, but in order to drive that, we need to know how big the problem is."

Dr Rossolini said that the use of carbapenem antibiotics to control high levels of ESBL in the Midlands could actually help KPC take hold in the region.