Superbugs.

Pictures: Electronmicrographs of MRSA; film of MRSA; disinfecting a hospital ward; leg wound infected by MRSA; laboratory procedures at the Central Public Health Laboratories, North London; heartscan (ultrasound) showing damaged aortic valve; film of VRE (vancomycin-resistant enterococcus)..

Contributors: Prof. Gary French, Guy's and St. Thomas's Hospitals; Dr. Rosamund Cox, consultant microbiologist, Kettering Hospital; Dr. John Boyce, East Glamorgan NHS Trust; Dr. Barry Cookson, Director, Hospital Infection, Public Health Laboratory Service, North London; Dr. Michael Zeckel, Eli Lilley Research Laboratories; Dr. Peter Davies, Director, TB Research Unit, Liverpool NHS Trust; Dr. John Moore-Gillon, East London TB Service; Prof. Bill Noble (University of London); Dr. Geoffrey Scott (Hospital Infection Society).

The main part of this programme is concerned with MRSA infection in hospitals; the final third of the film examines drug-resistant tuberculosis and then returns to the subject of MRSA and the prospect of it becoming even more virulent. The reporter is Tom Mangold.

A woman describes her shock at her husband's death in hospital, where he was being treated for a fractured leg. The cause of his death was the common bacteria MRSA (staphylococcus aureus).

MRSA - electronmicrograph. Staphylococcus aureus normally lives harmlessly on the surface of the skin but if it enters the blood stream it can cause blood poisoning and pneumonia. Antibiotic mis- use is responsible for its resistance to the antibiotics that were once effective against it. Prof. Gary French (Guy's and St. Thomas's Hospitals) says that there is now a nationwide epidemic of MRSA infection.

MRSA - film. South East England is badly affected by the epidemic, which started at Kettering Hospital in 1991 with an outbreak of MRSA 16 - the most devastating strain to date. It was identified by consultant microbiologist Dr. Rosamund Cox, growing on wound swabs from a leg amputation.

MRSA - electronmicrograph. Because patients carry it on their skin, displaying no symptoms, it can spread through the wards undetected. In May 1991 the first death from MRSA occurred at Kettering Hospital when a patient recovering from routine surgery developed a chest infection which led to fatal pneumonia. This patient had been in other wards; the infection had already spread and the hospital had to postpone or cancel operations on major blood vessels, as these patients would be in the greatest danger from MRSA. One man had to have his hip replacement removed because a drug-resistant infection developed in the joint. At Dr. Cox's request the hospital's major outbreak plan was implemented. The number of new cases dropped slowly but infection control on this scale was too expensive to continue indefinitely. After one year Dr. Cox was asked to find a cheaper method. To date there have been 16 deaths in 1000 cases of MRSA infection. At the time that this film was made, Kettering's MRSA infection was under control but there is no ultimate solution. Even if the hospital were closed, a new patient could easily bring the infection back in.

Hospital after hospital in the southeast, including King's College Hospital and Guy's, succumbed to MRSA then it spread to Glasgow and Wales. The bacteria became resistant to the creams used to kill it on the skin. Normally, 1 in 10 people carrying MRSA could expect to become infected but in the hospital group run by the East Glamorgan NHS Trust, nearly 15% of carriers became infected. In 1994, there were 49 cases and in 1995 there were over 300 - both patients and staff.

Hospital ward being disinfected. The East Glamorgan NHS Trust had to close seven wards. Now, control but not eradication is being achieved. The transfer of patients between hospitals exacerbates the problem because some hospitals will not admit that they are infected.

The Central Public Health Laboratories, North London, (laboratory procedures shown) runs an anonymous service, warning the hospital concerned of each sample that reveals an infection. Dr. Barry Cookson confirms that MRSA has now become an epidemic. The WHO has called for urgent global measures to combat antibiotic-resistant infection. MRSA has its social casualties as well as its physical ones. Doris Swain contracted MRSA after she had a leg amputated. It was cured, but she remains a carrier. When discharged from hospital, the social services refused to visit her lest she pass on the infection. Nursing homes refused to have her to convalesce. Mrs. Swain lives with her daughter but must keep at a distance from her grandchildren for fear of contaminating them. MRSE is now a threat in the community, in old people's homes, day centres - anywhere where there is care in the community. Ray McNeill contracted MRSA after a leg injury. He describes, from a patient's point of view, the alarming experience of being suddenly subjected to isolation procedures. Now discharged, he cannot work. Although the infection has been arrested the wound will not heal and the fear and incomprehension aroused by MRSA have left him socially isolated.

There is only one antiobiotic left - Vancomycin - which is effective against MRSA, but what happens when resistance develops? Already, there exists a vancomycin-resistant enterococcus (VRE), which lives harmlessly in the intestines. Set loose in the bloodstream, it becomes a killer. A baby, in hospital for burns treatment, contracted meningitis through VRE. Now, the burns are the least of his problems. In desperation, he is being treated with an experimental drug. Between 1988 and 1994 there were 44 hospitals with at least 1 case of VRE. 11 had clusters of cases. A leukaemia patient contracted it after a bone-marrow transplant, and died. Dr. Michael Zeckel (Eli Lilley) fears we are returning to pre-penicillin times when infections could kill in 48 hours and even small ones could be lethal.

At the TB Investigative Laboratories in South London, drug-resistant TB is a small but increasing problem. A patient describes the devastating effects of the illness. He is resistant to the 3 best antibiotics and will need at least 2 years' treatment. Out of 10 possible drugs, only 3 are still effective for him. Dr. Peter Davies of the TB Research Unit, Liverpool NHS Trust, now sees 1 in 5 or 6 TB patients with multi-drug resistant TB. In the worst cases, the only option left is surgery, the classic pre-antibiotic treatment. Dr. John Moore-Gillon, East London TB Service, is surprised to find himself resorting to a method long out of date when he trained in the 1970s .

MRSA nearly caused the death of a patient who had a hole in the aortic valve of his heart. The infection developed there, increasing the size of the hole. Antibiotics of last resort failed to quell the infection, so the damaged area had to be cut away to save his life. Dr. Zeckel suggests that bacteria can send their genetic information to other bacteria in the vicinity, rapidly escalating the growth of drug resistant strains.

Film - VRE (?). Suppose VRE transferred its virulence to MRSA? A laboratory-created sample exists. Prof. Bill Noble (University of London) sees no reason why this will not occur naturally and calls for innovative research to address the problem of drug-resistant infections in hospitals and in the community. Dr. Geoffrey Scott says that hospital infections are encouraged by the crowded condition of most British hospitals, which are now run with little or no spare capacity.

United Kingdom : BBC TV, 1996.

1 videocassette of 1 (VHS) (40 min.) : illustrations, color ; cm.

Broadcast television.

Copyright status: BBC TV.

Open Access.

Dawkins Associates.