Almost untreatable superbug CPE poses serious threat to patients, doctors warn

Doctors are warning that the rise of an almost untreatable superbug, immune to some of the last-line antibiotics available to hospitals, poses a serious threat to patients.

The number of lab-confirmed cases of the bug, called carbapenemase-producing Enterobacteriaceae (CPE), rose from three to nearly 2,000 in the 12 years to 2015, according to Public Health England (PHE). But that may be far short of the real number because hospitals are not compelled to report suspected cases. PHE admits it does not know where the infections are coming from or how many people are dying.

Freedom of information requests made by the Bureau of Investigative Journalism reveal that at least 81 people infected with CPE have died since 2009 at 66 NHS trusts in England – although the bug may have been a complicating factor rather than the main cause of death in some cases.

But the real figure is almost certain to be much higher. Many trusts did not respond to the requests or were unable to supply complete data. Out of 136 NHS hospital trusts that were asked for the numbers of infections and deaths between 2009 and 2016, 97 responded but nearly half did not have data on CPE or could not extract the details.

In Manchester and London, dealing with CPE has cost NHS trusts almost £10m. There have also been confirmed outbreaks in Liverpool, Leeds, Sheffield, Birmingham, Nottingham, Colchester, Edinburgh, Belfast, Dublin and Limerick, among others.

Elsewhere, Italy had only sporadic cases of CPE in 2009 but by 2014, the bugs were rife across the country. “If you look at Italy they’ve suspended bone marrow transplant programmes,” said Dr Matthew Laundy, consultant medical microbiologist at St George’s University Hospitals NHS Foundation Trust. “If you’ve got no antibiotics to treat CPEs you’re stuck.”

Experts are calling for reports of suspected CPE infections to be made mandatory. The numbers revealed by the Bureau are “shocking,” said Val Edwards-Jones, emeritus professor of microbiology at Manchester Metropolitan University.

“It should absolutely be mandatory for trusts to report this,” she said. “If you go back to the 1990s MRSA [reporting] wasn’t mandatory. It was only when hospitals did proper surveillance and began looking at the bugs in the blood that we knew the scale of the problem. Then it was found that there were certain things that weren’t being done correctly.”

Dr Michael Cooper, a consultant microbiologist and director of infection control at the Royal Wolverhampton NHS Trust, said: “If something’s not mandatory, it’s the places doing well that take care to report. You don’t get figures from the trusts with their head in the sand, the poor performers.

“Public Health England have no idea how many people are dying, they’ve no outcome data. This is a serious mistake.”

CPE is carried harmlessly in the gut, but may kill if it enters the bloodstream through a wound of a patient who is already sick or frail, which makes it a real danger in hospitals. About 40-50% of patients with a CPE bloodstream infection die. CPE is not untreatable, but it is difficult as antibiotic combinations or older, more toxic drugs have to be used.

CPE, dubbed the “nightmare bacteria” by Tom Frieden, former head of the Centers for Disease Control and Prevention in the USA, has developed resistance to the carbapenems, a group of “last resort” antibiotics that are used in serious infections when other drugs will not work. They include KPC (Klebsiella pneumoniae carbapenemase) and NDM (New Delhi Metallo-beta-lactamase).

Experts have warned that antibiotic resistance is a major threat to the world and could turn the clock back on medical advances by making some surgery, such as heart transplants, impossible.

There are high levels of CPE in India, Bangladesh, Pakistan, the Middle East, south and Central America, China, southeast Asia, Taiwan, Japan, some countries in southern Europe and the USA. In February the World Health Organisation named carbapenem resistant bugs a “critical priority” for which new antibiotics are urgently needed.

In 2014, the medical directors of both Public Health England and NHS England took what they called “the unusual step” of writing to all NHS Trust chief executives, urging them to take action to prevent the spread of CPE.

“CPE represents one of the most serious emerging infectious disease threats that we currently face, and the failure to control their spread now, while we still have the opportunity, could have substantial human health and financial consequences,” wrote Dr Paul Cosford and Sir Bruce Keogh.

However, Professor Alan Johnson, head of the department of healthcare-associated infection and antibiotic resistance at PHE, said patients should be reassured that infections caused by CPE can usually be treated with other antibiotics. Fewer than 2% of E coli or Klebsiella bloodstream infections are resistant to carbapenems, he said.

“We carry out enhanced surveillance on carbapenem-resistant bacteria to determine the numbers and different types of CPE. Although reports of CPE have increased recently, part of this may reflect increased laboratory testing of many sample types other than blood stream infections, as awareness of CPE has grown,” he said.

Manchester

New figures show that four times as many people have died as had previously been reported in an outbreak in Manchester.

In 2009, the first cases of a type of CPE called Klebsiella pneumoniae carbapenemase were detected. In 2014, the hospital trust confirmed that 14 people had died from this infection, contracted within the hospital, in the previous four years.

But the Bureau’s research shows that there have been 61 deaths in the last seven years, including a six-year-old boy with leukaemia who caught the infection while undergoing a bone marrow transplant.

Many of those affected were very ill and had underlying medical problems and so it is not known whether the infection directly caused their death. Some may have died with a CPE infection rather than from it.

An investigation into the outbreak found in 2015 that CPE bacteria were living in the hospital kitchen sinks and handwash basins, which had drains that allowed splashback. Hugh Pennington, a leading microbiologist who chaired official inquiries into E coli outbreaks in 1996 and 2005, said such basins elsewhere in the NHS should be replaced. “It’s all about sound plumbing. It’s not rocket science. If your sink is going to spread the bug, get rid of it.”

Almost untreatable superbug CPE poses serious threat to patients, doctors warn

Junior doctors" sleep deprivation poses threat to patients, says GMC

Trainee doctors in the NHS are often so sleep-deprived that they are in danger of harming patients, the medical profession’s regulator has said.

Increasingly heavy workloads and widespread staff shortages mean the UK’s 54,000 junior doctors are being left to look after wards of patients without proper experience, according to the General Medical Council’s biggest annual survey of trainee medics’ experiences

One in four doctors below the level of consultant say their schedule leaves them sleep-deprived and 43% describe their workloads as heavy or very heavy. Those with the most intense schedules are much more likely to encounter patient safety being put at risk, the survey found.

In one unnamed hospital, a junior doctor was the sole medic left in charge of 300 patients overnight – a case the GMC’s chief executive, Charlie Massey, said was extremely concerning. The risk of the doctor being unable to deal with two medical emergencies happening simultaneously meant such lack of cover should never happen, he said.

“Patients who are in hospital overnight are in a hospital for a good reason and if something should happen to one or more patients during that nightshift, and that trainee has been left alone, that creates real potential risk to patients,” Massey said.

He said he was “astonished” to have learned that a single doctor had been left unsupervised and having to handle the care of so many patients.

The proportion of trainees describing themselves as sleep-deprived rose from 21% in 2012 to 24.4% this year. “This is an increasing and worrying trend and it’s very concerning when doctors say that it’s jeopardising their ability to make good judgments and to provide safe care,” Massey told the Guardian in his first interview since taking up his role last month.

“Sleep deprivation matters because [tired] doctors may not remember all of the things that they should remember – for example, all the things to do to safely intubate an individual – because they are so knackered or may not remember all the patient’s history and may therefore make the wrong clinical judgment about them.”

Massey is so worried by the potential for patients being harmed by rising fatigue and workload pressure among hospital doctors that he has written to every NHS provider of care across the UK warning them to take steps to ensure the safety and quality of care are protected.

“Those responsible and accountable for the delivery of medical education locally must take the appropriate steps to ensure the training of doctors remains protected, particularly as medical training is so often a bellwether for the quality and safety of patient care, and because patients are directly at risk if the support and supervision of doctors in training is inadequate,” he wrote in the letter.

A separate survey of junior doctors, undertaken by the Royal College of Physicians and published on Wednesday, found that 80% of trainee medics say their job sometimes or often causes them excessive stress.

One in four of the 498 junior doctors surveyed by the RCP said their job seriously affected their mental health and 54% said it affected their physical health. Pressure on trainees had reached a “harmful and unsustainable level”, the college said.

Massey said the demands being placed on trainees were now so great that there was a risk of some being “used and exploited” by their hospitals because there were too few staff to cope with the work that needed to be done.

“We have seen some signs that that is beginning to happen,” he said. The GMC, which supervises all doctors’ training, fears that some are not getting the training they need and the next generation of consultants may not be as highly skilled as they need to be.

Massey also voiced unease that the quality of handovers from one set of doctors to another – which are integral to patients receiving good care – had emerged as a growing concern. Young doctors’ clinical education is also being interrupted by them being called out of training sessions to attend to problems involving patients, the GMC found.

Key medical specialties that have seen some of the sharpest rises in demand from patients – such as A&E, acute internal and general medicine, respiratory medicine and gastroenterology – are those where trainee doctors’ workloads have increased significantly in recent years, the GMC found. A total of 53,835 junior doctors – just under 99% of the 54,563 across the UK who were eligible to complete the GMC survey – took part.

Dr Pete Campbell, of the British Medical Association’s junior doctors committee, said: “Patients and the public may be shocked by these findings, but no junior doctor will be surprised. It is still far too common that junior doctors are left sleep-deprived after regularly working beyond their rostered hours, on rotas that are desperately short of doctors.”

NHS Employers said the new contract being imposed on junior doctors in England, which prompted the recent year-long industrial dispute between the BMA and the government, would remove or mitigate many of the concerns behind their rising dissatisfaction.

“We want to support our junior doctors,” a Department of Health spokesman said. “That’s why the NHS has employed 11,900 more doctors since 2010. Yesterday, the health secretary announced plans to improve junior doctors’ training, including more support from consultants, more notice of future placements including where couples are placed, reviewing the appraisals process and investing £10m to bring doctors back up to speed when they take time out to have a family or other caring responsibilities.”

Junior doctors" sleep deprivation poses threat to patients, says GMC

Whooping cough poses greatest chance to California youngsters, officials warn

Public wellness officials warn that whooping cough poses the best danger to younger kids as California discounts with its worst outbreak of the respiratory disease because 2010, with almost three,500 reported victims so far this year.

“Prevention of pertussis is specifically critical in youthful infants simply because they are the ones at chance for serious ailment and death,” Dr Gil Chavez, state epidemiologist and deputy director of the California Department of Public Well being, stated on Monday.

Infants, in certain, are the most vulnerable to the disease which triggers severe, uncontrollable spasms of coughing that can make breathing tough, and public well being officials urged parents to make sure their youngsters are appropriately vaccinated.

Vaccines also are advisable for pregnant women and adults who have increased make contact with with young young children.

California public wellness officials mentioned on Friday whooping cough, also identified as pertussis, has reached epidemic proportions in the state.

A lot more than 800 circumstances have been confirmed statewide in the initial two weeks of June alone, with Napa, Sonoma and Marin counties close to San Francisco Bay reporting the highest costs of infection per capita.

The highly contagious bacterial infection strikes 30 million and 50 million individuals each year around the world and kills about 300,000 annually, largely young children in the creating planet.

In the United States, the place outbreaks have a tendency to run in cycles, most kids are immunized against pertussis with a vaccine provided as a series of shots starting as early as six weeks of age. Pregnant women should get the vaccine in their third trimester because antibodies will be passed on to their newborns, Chavez stated.

Pertussis in youthful kids normally starts with a runny nose and occasional coughing for up to two weeks, escalating into bouts of extreme coughs punctuated with a characteristic “whooping” sound.

Infants typically do not exhibit the traditional signs and symptoms but may gag or gasp, and their faces may possibly turn red or purple for the duration of these spells, Chavez mentioned.

As of June 10 of this 12 months, 3,458 circumstances of pertussis have been reported during California, far surpassing the 2,530 folks diagnosed with the ailment statewide for all of 2013.

Of this year’s tally, 119 sufferers have been hospitalized, most of them under four months of age, and one, a five-week-previous infant, has died.

This year’s outbreak so far pales in comparison to a whooping cough epidemic that struck California in 2010, when 9,000 instances, such as 10 infant deaths, have been reported.

Whooping cough poses greatest chance to California youngsters, officials warn

Fiona Nash says staffer’s curiosity in wife’s lobbying company poses "no conflict"

The assistant wellness minister, Fiona Nash, says her chief of workers has “no conflict of interest” simply because he “receives no income” from a “shareholding” in his wife’s lobbying company, which represents chocolate and soft drink makers, but the opposition says there has been a “serious breach” of specifications.

Getting initially insisted that her chief of employees, Alistair Furnival, had “no connection whatsoever” with the organization, she conceded that Furnival, who intervened to pull down a healthy foods rating site that had been opposed by elements of the foods business, was a “shareholder in the lobbying firm owned by his wife, Tracey Cain, Australian Public Affairs (APA)”.

APA acts for Cadbury’s parent business, the snack foods giant Mondelez, as properly as soft drink sector group Australian Drinks Council. Furnival was when chairman of APA and chief economist for Cadbury.

Investigations by Guardian Australia present he also remains a director of one particular of three businesses that type the APA partnership, which is registered with NSW Honest Trading.

The government’s “standards for ministerial staff” need that personnel “divest themselves, or relinquish manage, of interests in any private organization or company and/or direct curiosity in any public business involved in the spot of their ministers’ portfolio responsibilities”.

Nash also conceded that Furnival had not declared any conflict of interest at a meeting of federal, state and New Zealand ministers on December 13, which Nash chaired and Furnival attended, and which voted to approve the wholesome meals rating scheme.

“Yes, I can verify it was an item on the agenda. Yes, I can verify that I was chairing the meeting. Yes, I can confirm that my chief of staff did not declare an interest.

“I was completely mindful of the romantic relationship amongst my chief of employees, APA and his earlier position inside Cadbury and the confectionery market … my chief of workers complies with suitable inner standards under the statement of requirements for ministerial workers,” Nash said underneath a sustained opposition assault for the duration of Senate query time.

“Operating procedures” for the legislative and governance forum on food regulation call for that “members and supporting workers have a responsibility to disclose and take affordable methods to steer clear of any conflict of curiosity, true or obvious, in connection with their membership or help of the Forum or its subordinate bodies.”

Nash said she had had discussions with the prime minister’s workplace soon after the conflict of interest claims had been aired earlier this week and was assured that the arrangements in place meant he “complies with appropriate inner standards”.

“I am assured there is no conflict of curiosity,” Nash insisted.

But veteran Labor senator John Faulkner mentioned the revelations represented “serious negligence in her carry out of her ministerial responsibilities” and a “very significant breach”.

Late on Tuesday Nash unveiled that Cain had given undertakings that both she and the organization would not make representations to both Nash, wellness minister Peter Dutton or the Division of Wellness.

“On the tips accessible to me these undertakings have been honoured in total,” Nash informed parliament. “Indeed, neither my chief of workers nor my office has met with Mondelez – formerly Kraft – the owners of Cadbury, with whom he worked as a chief economist.”

The prime minister promised Cadbury $ 16m prior to the election to upgrade their factory.

Nash confirmed on Tuesday that Furnival, on her orders, intervened to pull down a healthy food internet site that rated packaged food on a 1-five star basis. She said the website had been launched prematurely.

The voluntary method had been two and a half years in the generating and had been accredited by the forum of state, federal and New Zealand ministers, which has oversight of foods regulation. The forum took the unusual phase of voting to approve the system at the December meeting.

All public stakeholder groups were advised the site would be published last week but inside hrs Furnival rang the division to have it taken down.

The Guardian understands that when workers refused simply because they were below orders from the ministerial forum rather than the minister, Furnival went to the department ’s senior executive ranks to intervene.

Nash made the unusual move of incorporating to her question time response in the Senate adjournment debate just ahead of 9pm on Tuesday.

“In brief, each Mr Furnival and Ms Cain have taken suitable and suitable steps to prevent conflicts or possible conflicts between the personal business and his duties as my chief of workers by withdrawing from any work for consumers in the overall health portfolio,” she explained.

“At the time of answering Senator Wong’s question I did not have each and every detail of this details at hand, but, getting produced even more checks after question time I give this info to the Senate.”

APA is a partnership registered with NSW Fair Trading. NSW Honest Trading information demonstrate APA’s partners are 3 firms – APA Pty Ltd, Strategic Issues Management Pty Ltd and Centre for Litigation Communications Pty Ltd.

Australian Securities and Investment Commission paperwork display that Furnival is a director of Strategic Troubles Management Pty Ltd along with Tracey Cain, who is also secretary.

The chief executive of the Public Well being Association, Michael Moore, stated it was clear that some influence had been “brought to bear” and client and wellness advocates would be pushing to have the website reinstated.

“We have been really appalled and shocked when it came down,” said Moore, who was an independent member in the ACT Legislative Assembly and a former well being minister.

“There is clearly politics but we just to get the site back up. We have a voluntary code that some parts of the sector needs to get up.

“This was a method in spot ready to go and some influence had been brought to bear to deliver it down.”

Fiona Nash says staffer’s curiosity in wife’s lobbying company poses "no conflict"

Pill poses threat of blood clots, GPs warned

The danger of blood clots in the veins varies between CHCs, ranging from five to twelve circumstances per 10,000 girls a 12 months, in contrast with two circumstances a year per ten,000 ladies who are not utilizing the combined pill. Photograph: Stockbyte/Getty Images

Ladies in England making use of some of the most well-known brands of contraceptive pill are to be warned that they carry a chance of fatal blood clots.

The Medicines and Healthcare Merchandise Regulatory Agency (MHRA) advised GPs the hazards posed by mixed hormonal contraceptives [CHC], which incorporate two diverse female hormones, an oestrogen and a progestogen, were small and the benefits outweighed them but that females must recognize those risks.

The tips for GPs states: “The determination to use any CHC must be taken only following a discussion with the ladies to guarantee she understands: the effect of any intrinsic chance elements on her chance of thrombosis [eg deep vein thrombosis, pulmonary embolism, heart attack and stroke] the risk of thromboembolism with her CHC that she must be alert for indications and signs of a thrombosis.”

An alert was issued by the MHRA to GPs on 22 January following the European Medicines Agency (EMA) mentioned in November that the merchandise info for CHCs containing specified synthetic progestogen must be updated.

The EMA launched a review after France’s drug security company estimated that about twenty girls die each and every 12 months in France of blood clots linked to contraceptive use.

The EMA concluded: “The benefits of CHCs in stopping undesirable pregnancies carry on to outweigh their risks, and that the nicely-acknowledged chance of VTE [venous thromboembolism] with all CHCs is tiny.”

The company found that the risk of blood clots in the veins varies amongst CHCs, ranging from five to 12 instances per 10,000 girls who use them for a year, compared with two situations every single 12 months per ten,000 ladies who are not making use of CHCs.

A checklist for prescribers offered by the MHRA says a CHC should not be prescribed to specified ladies, including people with a history of a thromboembolic event or with quite high blood pressure, people who have had significant surgical procedure, or have a time period of prolonged immobilisation coming up.

It says the suitability of a CHC need to be mentioned with a female if they have specified risk elements which includes age, obesity and smoking and that if exposed to far more than one of those threat aspects it “might mean a CHC must not be utilised”. The MHRA advises that CHCs containing ethinylestradiol, a synthetic type of oestrogen, in mixture with particular sorts of synthetic progestogen – namely levonorgestrel, norgestimate, or norethisterone – are regarded to have the lowest threat of VTE.

A user card and patient details sheet are also supplied, detailing the risk. The former says: “The overall danger of a blood clot is small but clots can be critical and could in really uncommon situations even be fatal.” Women are warned to look for quick health care attention if they experience signs and symptoms such as significant soreness or swelling in either leg, sudden unexplained breathlessness, weakness or numbness of the face, arm or leg.

Dr Sarah Branch, deputy director of the MHRA’s vigilance and danger management of medicines division, stated: “Ladies should proceed to get their contraceptive pill. These are really risk-free, hugely efficient medicines for preventing unintended pregnancy and the benefits connected with their use far outweigh the risk of blood clots in veins or arteries.”

Pill poses threat of blood clots, GPs warned