A potentially deadly class of superbug has some Canadian hospitals stepping up screening, as infectious disease experts call for a reliable national warning system to report outbreaks.
At Fraser Health in B.C.’s Lower Mainland, hospitals have intermittently found cases of multidrug-resistant bacteria called Carbapenem resistant enterobacteriaceae or CRE. From summer 2012 until the end of 2013, 41 affected patients have been identified.
The overall group of bacteria normally live in the human digestive system. If those bacteria get into the wrong areas of the body, such as the blood or bladder, severe infections can occur. Some of these bacteria also have enzymes that give them resistance to last-resort antibiotics called carbapenems. The director of the U.S. Centers for Disease Control last year called the superbugs "nightmare bacteria."
"To reduce the risk of the organism spreading, Fraser Health is currently implementing a screening process for all patients admitted into our hospitals, particularly those being treated in our intensive care units," a spokeswoman for Fraser Health said in an email to CBC News on Thursday.
"The screening process will involve asking whether or not patients have been admitted into a hospital or received renal dialysis outside of Canada within the past six months. Anyone who answers yes to the screening question will be tested for CRE."
The screening is important in treating patients such as David Ricci, 22, of Seattle, who was infected with CRE in 2011. Ricci was taking a shortcut to his volunteer job at an HIV/AIDS clinic in Calcutta when his leg was pinched under a train in an accident, severing the arteries.
After he was airlifted home for treatment, doctors were in the dark about how to treat the thigh infection once they discovered he tested positive for CRE.
"The antibiotics that they did have didn’t do anything. The only way to remove the infection was to surgically cut it out," Ricci said. He now has a prosthetic leg and is studying with the goal of going to medical school for a career in infectious disease.
In the U.S, the CDC maps states with confirmed cases of CRE.
Silence on outbreaks
"There's not a lot of apparent and transparent information available in Canada yet," said Dr. Lynora Saxinger, an infectious diseases specialist at the University of Alberta in Edmonton. "Perhaps because of fear of alienating the public and creating a crisis of confidence in the public, there is a bit of a tendency to try and minimize issues like this and try to avoid widespread knowledge about such outbreaks."
To have a culture of safety, information about outbreaks and how the risks are being managed needs to be communicated, Saxinger said.
"Often these outbreaks may be occurring and we don’t even know about them," said Dr. Michael Gardam, an infectious disease specialist at Toronto General Hospital.
When hospitals across Canada are left unaware of cases at other Canadian hospitals, they don’t screen for CRE, and people who are colonized and not ill can spread the resistant bacteria to other patients and health-care workers, Gardam said.
"We’re looking at potentially expanding that [beyond travellers] and starting to screen all patients coming to certain parts of the hospital," such as the ICU, he said, since travel history alone may no longer reflect the risk. The goal is to stay one step ahead of resistant bacteria.
The Public Health Agency of Canada has limited surveillance of 57 mainly teaching hospitals. The agency’s latest published data shows three deaths where CRE was the main or contributing cause of death between 2010 and 2012. There were 160 cases reported during that period.
The national information doesn’t provide real-time information that doctors want, Gardam said.
In the U.S., several states have CRE surveillance set up and Europe is a little farther ahead, Saxinger said.