Canadian hospitals need better warning systems when it comes to CPE, a potentially lethal superbug that has established a foothold in British Columbia, says a medical microbiologist who helped launch a provincial surveillance program for the bacteria.
"One of the main challenges for the hospitals in B.C., as well as [elsewhere in] Canada and the rest of the world, is to maintain infection control and CPE alerts," Dr. Linda Hoang, a medical microbiologist with the British Columbia Centre for Disease Control (BCCDC), said in a recent presentation.
"And also clear communication between facilities – so if one hospital is going to send a patient to another facility, there needs to be very close communication and alerts to warn the other hospital that a CPE case is on its way."
Dr. Hoang's recommendations – made in a BCCDC presentation on Jan. 28 and subsequently posted online – echo those of other infection-control experts who have called for improved communication and even a national registry to monitor cases of CPE, or carbapenemase-producing enterobacteriaceae.
CPE are bacteria that have developed a resistance to carbapenems, powerful antibiotics often referred to as the "drugs of last resort." Healthy people can carry CPE without showing any symptoms. But the bacteria can cause problems when they travel into parts of the body where they do not belong, such as the urinary tract or bloodstream, and cause an infection. CPE infections can be fatal for up to 50 per cent of people who acquire them.
CPE are an emerging global threat and a pressing reality in B.C., where a cluster of cases emerged in 2013 and where an outbreak was declared earlier this week. Fraser Health Authority, one of five regional health authorities in the province, cited "sustained transmission" of the bacteria on a unit at Royal Columbian Hospital, whose shared patient rooms make it more difficult to prevent transmission. Fraser Health said it had taken steps to control the outbreak, including separating patients who have been "colonized" with the bacteria and additional cleaning.
Before that outbreak was announced, Fraser Health had implemented a screening and testing program, based on an increased number of cases it detected at sites beginning last summer. In that program, which is to be implemented at all Fraser Health sites this month, all patients admitted into the hospital are asked whether they have been admitted to a hospital or received renal dialysis outside of Canada within the past six months. Anyone who answers "yes" will be tested for CPE.
That screening is designed to detect CPE in people who may have acquired it outside of Canada and unwittingly brought the bacteria back with them. CPE is endemic in several countries, including India, China and parts of the United States. Infection control experts consider Fraser Health's sizable South Asian population as one of the factors in CPE's appearance in the region.
Fraser Health found 41 patients with CPE between last July and the end of the year. Most of those patients were colonized, not infected. Screening and control measures helped bring that number down to fewer than a dozen cases. The outbreak at Royal Columbian involves five patients.
Under Canadian regulations, it is up to individual health facilities to decide what constitutes an outbreak and whether public disclosure is required – a system that some infection control experts would like to see changed.
"I learn about these things through the media," Michael Gardam, an infectious disease specialist with the University Health Network in Toronto, said in a recent interview. "Which is not ideal. You kind of want to know what's going on. And we're clearly very far away from that."
In her presentation, Dr. Hoang said more work is needed to determine what strains of bacteria are involved and how they spread, saying such knowledge could help thwart transmission.
What is a superbug and why is it resistant to antibiotics? Click here for explainer