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Published Date: 2004-07-18 23:50:00
Subject: PRO/EDR> E. coli, ESBL - UK (Shropshire) (02)
Archive Number: 20040718.1952

E. COLI, ESBL - UK (SHROPSHIRE) (02)
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[1] E. coli, ESBL - UK: HPA
[2] E. coli, ESBL - UK (Shropshire): microbiology
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[1] E. coli, ESBL - UK: HPA
Date: 16 Jul 2004
From: ProMED <promed@promedmail.org>
Source: BBC Online [edited]
<http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/3901375.stm>

Inquiry into E. coli infections
------------------------
The number of urinary tract infections, and cases of blood poisoning,
caused by drug-resistant E. coli bacteria has jumped sharply. The Health
Protection Agency has recorded more than 400 cases in the past 12 months.
Prior to 2003, just a few cases were recorded at its labs each year. The
HPA has launched an investigation into the rise, and will report its
findings later this year [2004].
The infections are caused by strains of E. coli that produce enzymes called
extended-spectrum-beta-lactamases (ESBL). These enzymes enable the bugs to
destroy, and thus become resistant to, certain antibiotics.
ESBL-producing E. coli still only account for a very small proportion of
all urinary tract infections. However, it is important that they are
recognized rapidly, so patients can be given drugs that work.
Fatalities:
The HPA stresses that, as it not mandatory to report cases of ESBL E. coli
infection, the true extent of the problem is still unclear. It is aware
that some patients who have been infected have died, but, cannot say
whether the infection was a direct cause of their death.
Professor Pat Troop, HPA chief executive, said: "It is important that
health professionals and laboratories are aware of this problem so that the
correct testing can be carried out, and, that patients are given the most
effective treatment. There are very few antibiotics that remain effective
in the treatment of these infections, and, for some patients, it is
necessary for them to receive hospital treatment so that intravenous
antibiotics can be given. Therefore, we in the Agency are taking ESBLs very
seriously and have issued advice already to laboratories to help them in
the detection of these infections. We have also alerted GPs to the need to
send specimens to a laboratory, if a patient's infection is not responding
to 1st-line antibiotic treatment. Our specialists have also been working
closely with colleagues in other countries to determine how significant a
new threat these infections represent."
Professor Troop said that, for most people, a UTI, although unpleasant, is
easily treatable, and they will make a full recovery.
--
ProMED-mail
<promed@promedmail.org>
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[2] E. coli, ESBL - UK (Shropshire): microbiology
Date: 18 Jul 2004
From: Dr. P.Badrinath <badrishanthi@hotmail.com>

With reference to the above, your readers might find the abstract of a
presentation, to be delivered at the HPA annual conference 13-15 Sep 2004,
of interest. This abstract is available on line from the conference web
site at:
<http://www.hpaconference.org.uk/session_abstract.asp?abstractNo=477>
Title: The role of descriptive epidemiological study to guide the
investigation and management of an on-going outbreak of infection due to
ESBL (Extended Spectrum Beta-lactamase) producing Escherichia coli in
Shropshire.
Authors: Doroshenko A, Patel D, Carr R (Shropshire and Staffordshire HPU,
Shrewsbury) Warren RE, O'Neill P, Harvey G (Shrewsbury and Telford NHS
Trust) Pearson AD (Communicable Disease Surveillance Centre, London) Hawkey
P (Division of Infection and Immunity, University of Birmingham,
Birmingham) Woodford N, Livermore D (Antibiotic Reference Laboratory,
Health Protection Agency, London)
2 E.coli O25 strains with CTX-M-15 Extended Spectrum Beta-lactamase (ESBL),
and resistance to quinolones and trimethoprim, are causing simultaneous
community and hospital UTI (urinary tract infection) outbreaks in
Shropshire. One strain is gentamicin-susceptible and the other is
gentamicin-resistant. The availability of identification methods for
urinary isolates permitted the detection of this outbreak. Cases of UTI due
to ESBL producing E.coli were confirmed to emerge from March 2003 onwards.
The Outbreak Control Team instituted an epidemiological surveillance of
cases. 70 gentamicin-susceptible and 35 resistant infections were
identified by the end of October 2003, including 5 bacteraemias. Epidemic
curves for the 2 strains appear similar in shape and time course. We
devised the questionnaire to elucidate the pattern of acquisition of
infection, and, administered it to the gentamicin-sensitive group. Over 90
percent of infected cases diagnosed from community samples were admitted to
a Shropshire acute hospital in the 3 years prior to their microbiological
diagnosis. 50 percent of gentamicin-susceptible cases were catheterized,
and 75 percent reported having taken antibiotics in the previous 3 years.
No food source was implicated. 15 deaths occurred, but this was against a
background of an elderly population with significant co-morbidity.
The findings led to the revision of antibiotic-prescribing policies and
review of hospital isolation strategy. Further epidemiological study, and
collaboration with other regions where similar outbreaks occurred, are
on-going.
--
Dr. P.Badrinath MD, BS, M.Phil, MPH, PhD (Cantab), MFPH
Southend-on-Sea PCT & University of Cambridge, UK
[The news story in part 1 describes over 400 cases of ESBL E. coli reported
to HPA over a similar time period as the 105 cases reported in Shropshire
in ProMED-mail report 20040715.1920. It is not clear from the BBC story
what geographic area is represented, but presumably, this includes the
Shropshire cases and those from other areas. The scientific abstract,
brought to our attention by Dr. Badrinath, provides additional details
regarding the Shropshire isolates. ESBL-producing gram-negative bacteria
have become alarmingly common around the world. - Mod.LM]

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