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Home News centre National Press Releases 2011 Press Releases ›  New HPA guidance on tackling emerging antibiotic resistance

New HPA guidance on tackling emerging antibiotic resistance

31 January 2011

New guidance has been developed by the Health Protection Agency (HPA), in conjunction with the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI), to advise on the management of patients who are infected with bacteria resistant to carbapenem antibiotics.

Carbapenems are powerful broad-spectrum antibiotics that are often the last line of effective treatment for patients with infections - including hospital pneumonias, urinary infections or blood poisoning - caused by strains of the bacteria Klebsiella and E. coli that are already resistant to more widely used antibiotics.

The guidance, being issued to all consultant medical microbiologists and infection control specialists across the UK:

  • advises how hospital laboratories can best detect carbapenem-resistant bacteria; 
  • stresses how the effective use of good infection control practices, such as screening and isolation of high risk patients, can help to contain the spread of infection;
  • describes the few treatment options that do remain.

The geographical distribution and epidemiology of different types of carbapenem resistance is also outlined.

The guidance has been developed in response to enquiries from microbiologists and infection control specialists on the appropriate use of antibiotics following the identification of cases of infection with resistance to carbapenems, including those with the NDM-1 (New Delhi metallo) beta lactamase enzyme, which was described in a paper co-authored by the HPA and published in the Lancet Infectious Diseases in August 2010.

Aside from NDM-1 the HPA reports that other carbapenemases (enzymes that destroy carbapenems) are being seen in the UK, for example Verona Imipenemase (VIM), Klebsiella pneumoniae carbapenemase (KPC) and OXA-48.

Dr David Livermore, director of the HPA's antibiotic resistance monitoring and reference laboratory, said:

"It is critical, always, to understand how much of modern medicine - from gut surgery to transplants - depends on the ability to treat infection.  If that ability is lost, through resistance, then medicine will take a great step backwards.

"The emergence of carbapenem resistance is a major public health concern and we hope this new guidance will help infection control specialists across this UK to better recognise, treat and prevent infections caused by bacteria with these resistances.

"This resistance makes infections much harder to treat. What's more NDM and the other enzymes that cause carbapenem resistance can be produced by many different types of bacteria, which can affect various body sites.

"The severity of the infections caused by bacteria with resistance to carbapenems varies. It depends on several factors including whether a patient has underlying medical conditions, his or her general health, and the site of the infection.

"The spread of antibiotic resistance underscores the need for good infection control in hospitals both in the UK and overseas, and highlights the need for new antibiotics to be developed.

"The World Health Organisation has recently emphasised the need for new antibiotics to be developed and for countries to take action to combat antimicrobial resistance, and this is a very welcome development."

The HPA conducts monitoring and surveillance on antibiotic resistance in the UK and has done so since the late 1980s. Surveillance is currently being undertaken for isolates that have been submitted to the HPA's Antibiotic Resistance Monitoring and Reference Laboratory and which were found to be carbapenemase-producers. The HPA also collaborates with pharmaceutical companies to undertake evaluations of new, developmental antibiotics against resistant bacteria, including those with carbapenemases.


Notes to editors

  • The new HPA guidance is available on the HPA website and issued to clinical microbiologists and infection control specialists across the UK by the HPA's Antibiotic Resistance Monitoring and Reference Laboratory.
  • The development of new antibiotics which can be used in place of carbapenems are detailed in recent journal articles such as in: Livermore et al. Activity of aminoglycosides, including ACHN-490, against carbapenem-resistant Enterobacteriaceae isolates. Journal of Antimicrobial Chemotherapy 2011 Jan;66(1):48-53. Epub 2010 Nov 14. 
  • More information about carbapenem resistance can be found on the HPA website.
  • The paper in the Lancet Infectious Diseases detailing the emergence of cases with NDM-1 [external link] is available from the Lancet website.
  • The HPA has a number of resources on the use of antibiotics, including new guidance on management of infections in primary care units  
  • Hospitals and healthcare professionals need to pay careful attention to the correct and appropriate use of antibiotics, ensure there is appropriate monitoring and surveillance of antibiotic resistance, and ensure appropriate infection control measures are in place. See the guidance on the correct use of antibiotics for healthcare professionals.
  • Members of the public should adhere to the correct use of antibiotics, not store any unused antibiotics, and ensure that they use them for the recommended duration as prescribed by their doctor.
  • For media enquiries please contact the national HPA press office at Colindale on 020 8327 7097/6647/6690, out of hours 020 8200 4400 or email


Re-issued 13:40 31.01.2011

Last reviewed: 11 November 2013