UK agency recommends better monitoring of multidrug resistant E coli
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《英国医生杂志》
The Health Protection Agency, the body that monitors and advises on infectious diseases in the United Kingdom, has recommended that monitoring of multidrug resistant Escherichia coli be improved. Its report, published this week, shows a big increase over the past four years in the number of infections associated with the bacterium.
The agency found that the number of infections caused by E coli bacteria that produce extended spectrum b lactamase (ESBL) was growing. Extended spectrum b lactamase is an enzyme that hydrolyses and confers resistance to modern cephalosporin antibiotics. The increase has occurred in the community and in hospitals. The bacteria normally live harmlessly in the gut but are also one of the commonest causes of urinary tract infections.
The agency said that more than 1000 isolates of one particular type of ESBL producing E coli had been reported to its Antibiotic Resistance Monitoring and Reference Laboratory since 2003 and that these strains had not been seen in the UK before 2000. Most of the new isolates were multi-resistant to aminoglycosides, fluoroquinolones, and trimethoprim as well as to all b lactams except the carbapenems and temocillin. Data for E coli septicaemia —which has doubled in the last decade to more than 17 000 cases a year in the community and in hospitals—confirm the increase in antibiotic resistance, which rose from 2% of cases in 2001 to 6% in 2004.
David Livermore, director of the monitoring laboratory, said: "The majority of ESBL producing E coli infections seen are sporadic cases, both in the community and in hospitals, and this highlights the fact that E coli bacteria causing these infections are generally becoming more resistant to antibiotics. Currently, there is no comprehensive surveillance of urinary tract infections in the community, so there is no reliable estimate of the number of infections caused by ESBL producing E coli strains in the community."
The report recommends extending mandatory surveillance to include urinary tract infections in the community to gain a better understanding of ESBL producing E coli. This would mean that GPs—probably from sentinel practices—would have to send urine specimens from patients with urinary tract infections to laboratories for microbiological analysis. To facilitate this, the report recommends that all public health microbiology laboratories should have standardised methods to detect ESBL producing E coli. It also says that GPs and other front line clinicians should be informed about the changes in E coli and the need to change treatment.
Dr Livermore said: "This is a problem. These organisms can cause severe infections, so it is vital that they are recognised quickly and an appropriate antibiotic is given." He reported that ESBL producing E coli was considered to have contributed directly to 10 deaths among the total of 54 deaths reviewed in the report.(Susan Mayor)
The agency found that the number of infections caused by E coli bacteria that produce extended spectrum b lactamase (ESBL) was growing. Extended spectrum b lactamase is an enzyme that hydrolyses and confers resistance to modern cephalosporin antibiotics. The increase has occurred in the community and in hospitals. The bacteria normally live harmlessly in the gut but are also one of the commonest causes of urinary tract infections.
The agency said that more than 1000 isolates of one particular type of ESBL producing E coli had been reported to its Antibiotic Resistance Monitoring and Reference Laboratory since 2003 and that these strains had not been seen in the UK before 2000. Most of the new isolates were multi-resistant to aminoglycosides, fluoroquinolones, and trimethoprim as well as to all b lactams except the carbapenems and temocillin. Data for E coli septicaemia —which has doubled in the last decade to more than 17 000 cases a year in the community and in hospitals—confirm the increase in antibiotic resistance, which rose from 2% of cases in 2001 to 6% in 2004.
David Livermore, director of the monitoring laboratory, said: "The majority of ESBL producing E coli infections seen are sporadic cases, both in the community and in hospitals, and this highlights the fact that E coli bacteria causing these infections are generally becoming more resistant to antibiotics. Currently, there is no comprehensive surveillance of urinary tract infections in the community, so there is no reliable estimate of the number of infections caused by ESBL producing E coli strains in the community."
The report recommends extending mandatory surveillance to include urinary tract infections in the community to gain a better understanding of ESBL producing E coli. This would mean that GPs—probably from sentinel practices—would have to send urine specimens from patients with urinary tract infections to laboratories for microbiological analysis. To facilitate this, the report recommends that all public health microbiology laboratories should have standardised methods to detect ESBL producing E coli. It also says that GPs and other front line clinicians should be informed about the changes in E coli and the need to change treatment.
Dr Livermore said: "This is a problem. These organisms can cause severe infections, so it is vital that they are recognised quickly and an appropriate antibiotic is given." He reported that ESBL producing E coli was considered to have contributed directly to 10 deaths among the total of 54 deaths reviewed in the report.(Susan Mayor)