'End of the line': Man loses leg to superbug after routine knee operation

'End of the line': Man loses leg to superbug after routine knee operation

Originally published on The Telegraph

A British man has had his leg amputated after contracting a superbug infection following what should have been a routine knee replacement.

He is one of a growing number of NHS patients for whom common operations are going horribly wrong because of the rise of antibiotic resistance.

Paul Tilley, 68, a former catering manager from Dalton in North Yorkshire, had his right leg removed before Christmas.

He contracted the bug after a simple knee replacement. 

Doctors battled to fight the infection over the course of six years and a series of follow-up operations but without success.

“The doctors don’t tell you you need a leg amputation – you have to take the decision yourself. But after six years of pain and not being able to live my life it was the only choice,” he says. 

Mr Tilley is one of a growing number of NHS patients to have fallen victim to the epidemic of antibiotic resistance that has been building over the last few years.

Data suggests there are at least 2000 superbug-related deaths in the UK each year, many linked to common but invasive operations such as hip and knee replacements.

Professor Dame Sally Davies, the Chief Medical Officer for England, warned in The Telegraph last year of a dark future for modern medicine unless the blight of antibiotic resistance could be tackled.

She predicted a future “where the types of intervention we routinely deliver today, such as caesarean sections, chemotherapy and hip replacements become extremely dangerous… due to drug resistant infections”. 

Officials estimate that at the current rate, 10 million people a year will die worldwide by 2050 because of the rise of superbugs.

Mr Tilley problems began almost as soon as his knee was replaced.

“Within a matter of days I was in the most tremendous pain. I was shaking and vomiting. The nurses had to call the surgeon out in the middle of the night because they didn’t know what to do with me,” he said.

His medical notes show a series of infections set in, including the superbugs meticillin-resistant Staphylococcus aureus (MRSA) and Enterobacter cloacae He received a wide range of antibiotics and endured three follow-up knee replacements but the infections could not be killed off. Surgeons even tried an artificial knee coated in silver, a metal known for its anti-bacterial properties. 

Mr Tilley said last week he had never heard of superbugs or antibiotic resistance before his first operation. Now he has become an expert, losing track of the the number of different antibiotics he has taken orally and by drip over the last few years.

“It’s like a row of soldiers. You knock one infection down but then another one pops up. You go home and you feel okay but then it’s all hiding there underneath the skin.

“It starts off as a little pimple or a red spot and then the skin turns black and gets swollen and incredibly painful,” he says.

The pain of the infection was the worst thing, said Mr Tilley.  It was so intense during a walking holiday in Spain he considered throwing himself off a mountain path. In the end he opted to have his leg amputated. 

“Between the microbiologist and the surgeon you could see they were fighting their way through this. They didn’t know what to do with me. There are no antibiotics for this – this is the end of the line,” he said. 

John Williams, an infectious diseases consultant at James Cook Hospital in Middlesbrough, said Mr Tilley had various resistant infections over the years.

“If you look at the figures on knee replacements about two per cent become infected – it’s a bit higher for the second knee and a bit higher for the third knee.

“The more operations a patient has there is less and less bone and soft tissue for the surgeon to work with so the replacements become that much more difficult,” he said. 

“When bone becomes infected you need to get high concentrations of antibiotics into it and not all oral antibiotics achieve that. And if you have a resistant organism it becomes harder because you have a limited number of options. The infections are treatable but you don’t have as many choices and you end up relying on drugs from the 1950s and 60s,” he says.

What Mr Tilley has gone through is still rare, says Dr Williams, but resistant infections are not.

“The numbers are going up and up. There’s a straight correlation between the number of antibiotics we use and the number of resistant infections,” he says.

Mr Tilley underwent the amputation in November and nearly two months later his stump is healing well and he is looking forward to having a prosthesis fitted in the next few months. 

Paradoxically, he says he will be more mobile without his leg – he has spent much of the last six years using sticks and crutches to get about and has been heavily reliant on his wife, Andrea. 

He says adjusting to life as an amputee will be hard but once he gets the hang of his prosthesis he hopes to be back to his previous, active self.

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