Hospitals are down to their last line of antibiotic defence against certain types of drug-resistant “superbugs”, experts warned yesterday.

The Health Protection Agency (HPA), which monitors infections, has called on pharmaceutical companies to develop new drugs in the face of increasingly-resistant bacteria, so that the number of effective treatments does not run out.

The Agency is particularly worried about a group of bacteria known as “gram-negative”, which are extremely common and include Escherichia coli.

Most people carry such bacteria with no harmful consequences. But they can cause infections in seriously ill patients or those with certain conditions such as cystic fibrosis, and the number of bacteria that are resistant to treatment is increasing.

E.coli is the commonest cause of urinary tract infections, causing about 70-80 per cent of all cystitis cases, and can also cause pneumonia and more serious bloodstream infections among hospital patients.

There are about 20,000 E.coli bloodstream infections each year in England, Wales and Northern Ireland, of which about 12 per cent (2,400) are resistant to antibiotics.

In 2000, about four per cent of E.coli bloodstream infections were resistant but this had risen threefold by 2006.

The HPA said this was because new types of resistant genes have developed in the E.coli bacteria.

David Livermore, laboratory director at the HPA Centre for Infections, described E.coli as the “big beast” among a number of other, less common infections, which are also proving resistant to treatment.

The HPA only monitors bloodstream infections which are reported to laboratories, but most resistance of E.coli occurred in older patients who represented complicated cases and tended to have already had repeated courses of antibiotics, he said.

“But it is becoming more resistant,” he added. “Hospitals are having to use what were second-line antibiotics first. We are not actually running out of antibiotics, however we are now having to use our last-defence antibiotics first in some hospital infections.”

Infections due to some drug-resistant superbugs, such as MRSA (methicillin resistant stapyloccocus aureus) are in decline due to better infection control. Dr Livermore said that there were several effective antibiotics to choose from for MRSA and a number of new options in the advance stages of development, but he added that the situation over gram-negative bacteria was not improving.

“If anything it’s worsening,” he said. “For example, with Acinetobacter there is sometimes only one treatment option available to doctors and in some rare situations gram-negative bacteria can cause infections that are untreatable.

“These multi-resistant gram-negative bacteria often cause infection in particular patient groups who are very sick such as those in intensive care units or those with chronic lung infections. This is a particular problem with Pseudomonas and Burkholderia in cystic fibrosis patients.”

Dr Livermore said there was a need for new antibiotics to be developed and called on pharmaceutical companies to invest in this area. Some firms have pulled out of developing the drugs in recent years as they were not seen as particularly profitable, he said.

"Antibiotic development, whether public or private, has to be made financially attractive and financially viable,” he said.

Whether this was by providing industry with incentives or by public investment was not for him to decide, he added.

He said clinical trials of new drugs should be reviewed to make it easier for them to be carried out.

Figures suggest that it costs between $500 million to $1 billion to bring new drugs to market.

“Antibiotics are a precious resource in fighting infections and one that we must do everything possible to preserve. This is why we need to ensure there is a constant range of options under development.”

He added that it was “a fact of life” that bacteria will always try to find a way to survive and develop resistance against the drugs.

“Resistance is also part of the price we pay for advances in medical technology and being able to keep sick patients alive for longer,” he said. “We can however try to minimise this problem by ensuring antibiotics are used sparingly and that a range of new treatment options is in development."

Professor Peter Borriello, Director of the Agency's Centre for Infections, added: “The problem of antibiotic resistance is likely to remain with us for the foreseeable future. But the fight against resistance is not futile. Efforts to control the problem will be long and complex but these efforts are already underway.”

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