EVERY Scottish hospital is to be put on alert for a new superbug that is resistant to normal antibiotics amid fears that Scotland is facing an outbreak.

Currently only half of all hospitals are monitoring the deadly strain of bacteria, which is responsible for dozens of deaths across Britain each year.

As part of a government crackdown every hospital laboratory in Scotland will be required to report all infections involving extended spectrum beta lactamase-producing (ESBL) coliforms.

They will also be issued with an action plan to deal with outbreaks, including the isolation of infected patients and the introduction of disinfection procedures to halt the superbug’s spread.

In Scotland, the number of confirmed ESBL infections has risen almost tenfold since 1999. With 220 cases reported by June, the 2004 tally is expected to overtake the record 420 infections identified in 2003.

The rising rate of infection has fuelled fears that Scotland could soon be hit by an outbreak similar to the one that killed 28 patients in Shropshire last year. Doctors believe the official Scottish figures represent the tip of the iceberg. Because so few hospitals are monitoring the bacteria, it is not known how widespread the bug is or the number it has killed.

ESBLs are mutated bacteria that are found in the gut. They produce enzymes that break down antibiotics and pose the greatest risk to patients with weak immune systems.

Like MRSA — the most common and deadly antibiotic- resistant superbug — they can kill by causing blood poisoning and can only be destroyed using special antibiotics that are reserved for serious infections.

Microbiologists fear that unless action is taken to tackle ESBL now, the bacteria could pose as grave a threat as MRSA, which affects 10,000 patients a year in Scotland. Together with other hospital- acquired infections, MRSA is responsible for about 500 deaths each year.

Professor Hugh Pennington, who led the inquiry into the Lanarkshire E-coli outbreak, which killed 21 people in 1996, welcomed the launch of the alert network. “We need an early warning system of the highest quality to prevent us being taken by surprise,” he said.

“Unless we have an aggressive surveillance programme we are not going to see off these bugs, which are undoubtedly causing more mayhem than we know about and killing people unnecessarily.”

Dr Ian Gould, the president of the Scottish Microbiology Association, is spearheading the offensive against ESBL. The alert network is being set up in conjunction with Health Protection Scotland and funded with a £40,000 grant from the Scottish executive.

“In some parts of the world clinicians would regard ESBLs as more of a problem than MRSA and they have the potential to become the new MRSA in this country,” he said.

“Only around half of the 30 or so hospital laboratories in Scotland are actively screening for ESBLs. Even then, different techniques are being used to identify them, some of which are more effective than others.”

Gould said firm action was needed. “While we don’t want to incite unnecessary panic, we don’t want ESBLs to gain the sort of prominence that MRSA has achieved. In England they are seeing a much more serious problem with ESBLs and it could easily happen here in the next few weeks or months.”

The scare has focused attention on the over-use of antibiotics in modern healthcare. Stephanie Dancer, a consultant microbiologist with Health Protection Scotland, said: “We want to know exactly how many of these organisms there are and identify who has got them so that we can give patients the best protection by using isolation rooms and introducing barrier nursing to prevent the spread of ESBLs.”

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