Superbug tied to health-care services outside of Canada, PICNet says

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A new surveillance program for a so-called superbug found 21 cases during the most recent quarter, most of them linked to health-care services that patients obtained outside Canada.

The data about Carbapenemase-producing organisms, or CPOs, was in a recently posted quarterly report – for the period between April 1 and June 18, 2015 – by the Provincial Infection Control Network of British Columbia, also known as PICNet. All but one of the cases were detected in the Lower Mainland, and 17 involved people who had received care outside the country, ranging from overnight hospitalization to surgical procedures.

Although the numbers involved are small, they are significant for health authorities.

"The big concern is that these bugs are carrying genes that harbour resistance to our really big-gun antibiotics," PICNet manager Bruce Gamage said on Wednesday.

"So if you have someone who is very ill and our treatment options become very limited … we are moving further and further down that road where we are going to see patients who have serious infections and we just can't treat them."

CPOs are part of an emerging global pattern of antimicrobial resistance. They are bacteria that have acquired genes that make them resistant to certain antibiotics, including carbapenems – last-resort drugs used to treat the toughest infections. People can carry CPOs in their gut without being sick, but when the bacteria spread outside the gut, they can cause serious infections.

CPOs are widespread in some parts of the world, including Greece, India and part of the United States. They have been on the scene in B.C. since at least 2008, and public-health agencies in B.C. have been monitoring a gradual uptick in cases since 2010.

After a CPO outbreak at B.C.'s Royal Columbian hospital in February, 2014, the province set up a mandatory surveillance program for CPO in acute care facilities. The CPO surveillance program is similar to those already in place for other bugs, including Clostridium difficile.

The definition of a CPO outbreak would vary from one facility to another, based on how many cases it usually sees and how quickly cases spread.

In the quarterly report, Fraser Health had 12 CPO cases during the period, Vancouver Coastal Health had eight and Interior Health had one.

The prevalence of cases in the Lower Mainland reflects a larger population base, major hospitals treating sicker patients who are more vulnerable to infections and people who travel to regions, including South Asia, where CPOs are widespread.

The most effective way to prevent CPOs, and most other bugs, is hand-washing.

In its annual report, posted in January, PICNet said the number of C. difficile cases in B.C. was the lowest since the surveillance program began five years ago.

As well, the rate of hospital-associated C. difficile fell from 8.6 per 10,000 inpatient days in 2010 to 4.2 per 10,000 patient days in 2015 – a decrease of 51.2 per cent. (PICNet uses the term "associated" rather than "acquired" in reporting on infections because even though people got sick after entering the hospital, it is not known when they actually acquired the bacteria).

C. difficile is a germ that can live in the bowel without causing harm. But when people take antibiotics, normal bacteria can be knocked out and C. difficile can flourish, releasing toxins that can cause diarrhea, fever and can be fatal.

C. difficile is the most frequent cause of infectious diarrhea in hospitals in Canada and outbreaks have turned up in several health authorities, including Fraser Health.

Fraser Health has several initiatives under way to fight infections, spokeswoman Tasleem Juma said on Wednesday, including enhanced cleaning when required. The authority has also hired a medical director for antimicrobial stewardship – a new position focused on preventing outbreaks and reducing their impact if they occur.