PVL superbug outbreak kills premature baby at hospital

A premature baby has died and five others have contracted the PVL superbug on the neonatal ward of a hospital in East Anglia.

It is the first outbreak of the PVL bug ever seen on the 28-cot unit at the Norfolk and Norwich University NHS Trust, the hospital said yesterday.

PVL-producing strains of Staphylococcus aureus are more toxic than ordinary bacteria and pose a particular threat to premature babies whose immune systems are not fully developed.

The strain identified in the Norfolk and Norwich outbreak is different from the MRSA strain which killed a nurse and a patient at the University Hospital of North Staffordshire, Stoke-on-Trent. The hospital said that it was easier to treat.

It is similar to the PVL bug that caused an outbreak on the maternity unit of Derriford hospital, Plymouth, in 2003 when 10 mothers and babies were infected and four developed extensive abscesses which needed surgery.

In the current outbreak in Norwich, none of the five babies on whom the bug has been detected were "actively infected" but they were found to be carrying it on their skin. They were being treated with antibiotics and their skin cleaned with antiseptic as a precaution, the hospital said.

The baby who died was born four months early. He was "very poorly" before he succumbed to an infection on 11 December, the hospital said. Tests showed he had a strain of PVL positive S. aureus, which may have been "a factor" in his death.

Judith Richards, a consultant microbiologist at the hospital, said the five babies being treated were "very vulnerable babies, who are very premature" and some had undergone surgery.

"With most of these babies, you would not be able to tell that they have [the bug]. It's only because we tested and swabbed them.

"All of the babies have been decolonised. We have used antiseptic to clean their skin and we are treating with antibiotics where appropriate. We have also re-cleaned all the cots.

"Some babies carry the strain on their skin, they are not suffering from any clinical infection."

Around 70 to 80 members of staff have also been screened, and parents where appropriate, she said. The unit has undergone "additional specialist cleaning" and has been closed to new admissions from other hospitals.

Dr Richards said: "We believe the control measures introduced mean that these babies, and others in the unit, are not now at any significant risk from this strain of S. aureus. Visiting on the unit had been restricted to parents only.

"We have taken prompt action to treat the babies concerned and we are working with the Health Protection Agency to identify the source of this infection."

The chief executive of the trust, Paul Forden, said: "Our neonatal unit cares for the very youngest and most critically ill of all our patients.

"It is tragic that this infection may have played a part in the death of a 27-week-old baby and our thoughts are with the parents concerned."

In September, Maribel Espada, 33, died when she contracted PVL-producing MRSA after giving birth by Caesarean section at the University Hospital of North Staffordshire in Stoke-on-Trent. Another patient also died at the hospital, with the outbreak affecting a total of 11 people.

Lethal bacteria

* Pantene Valentine Leukocidin (PVL) is a toxic substance produced by some strains of the bacterium, Staphylococcus aureus.

* It attacks white blood cells, destroys tissue causing skin infections and can cause blood poisoning and pneumonia.

* It can be produced by methicillin sensitive and methicillin resistant strains of S. Aureus - MSSA and MRSA.

* Even sensitive strains can be hard to treat. Daisy Lynch, three, who contracted PVL in the maternity unit of Derriford Hospital, Plymouth in 2003 has had 14 courses of antibiotics and two operations on abscesses caused by the bacteria.

* PVL-producing strains are mostly seen outside hospitals and tend to affect children and healthy young adults.

* The outbreak of PVL-MRSA in the University Hospital of North Staffordshire, Stoke-on-Trent, in September, which affected 11 staff and patients and caused two deaths, was the first time the resistant strain had been transmitted and caused deaths in hospital.

* There have been seven deaths in England and Wales associated with PVL-positive MRSA in the past two years, including the two at North Staffordshire, the Health Protection Agency said. Most were unrelated to hospital care.