A potentially deadly bacteria resistant to nearly all antibiotics has gained a foothold in the Lower Mainland, forcing the Fraser Health Authority to launch an aggressive campaign to contain it.
Fraser Health identifed 41 patients who were affected by carbapenem-resistant enterobacteriaceae (CRE) between last summer and the end of 2013, says Elizabeth Brodkin, FHA's medical director of infection prevention and control. That tally, which far surpasses the handful of cases reported by B.C.'s other regional health authorities, puts Fraser Health on the front lines of fighting what has been dubbed a nightmare bacteria.
And with about 10 people in Fraser Health facilities still carrying the bacteria – the number changes almost daily – the days of CRE being a rarity appear gone for good.
"We are still finding people who are colonized [by the bacteria] fairly regularly," Dr. Brodkin said in a recent interview. "We will continue to have patients who are colonized with this. And the more we screen, the more we are likely to find."
Fraser Health identified patients with carbapenemase-producing enterobacteriaceae, or CPEs – germs that produce an enzyme that breaks down antibiotics, rendering them useless. Most of the cases involved "carriers" who acquired the bacteria outside of Canada, but there were also some hospital-acquired infections, Dr. Brodkin said.
Demographics plays a role in where such organisms show up. Fraser Health serves communities including Surrey, which has a population of nearly half a million people, with nearly one-third of them of South Asian ethnicity. With people regularly travelling to and from countries where the bacteria are endemic, such as India, bacteria sometimes come along.
"This is something we have talked about very openly," Linda Hoang, a medical microbiologist with the B.C. Centre for Disease Control, citing the sizable South Asian population in the region. "They [Fraser Health] were aware and we were aware, over the last three years, that at some point this was going to happen."
The BCCDC worked with Fraser Health to address what the health authority is calling a "cluster" – not an outbreak – of cases and believes the numbers have been brought under control, Dr. Hoang said.
Dr. Brodkin would not say which Fraser Health facilities were involved. Nobody died as a direct result of the bacteria, but an undisclosed number of patients died with the bacteria in their systems. Some patients got CRE-related infections but doctors were able to treat them, she said.
Beginning last summer, Fraser Health implemented a screening program at some of its sites. In that process, patients being admitted to the hospital are asked if they have been admitted to a hospital or received dialysis outside of Canada within the past six months.
Anyone who answers "yes" will be tested for CRE. The program is expected to be in place at all Fraser Health facilities by next month. Other Canadian hospitals are taking similar precautions, with screening more common in large, teaching hospitals.
CREs, like other multidrug-resistant organisms, evolved as a result of the misuse and overuse of antibiotics. They are resistant to nearly all antibiotics, including carbapenems, often referred to as the drugs of last resort. Up to 50 per cent of people who get a carbapenem-resistant infection in their bloodstream die as a result. And CREs can spread their resistant characteristics to other bacteria.
Endemic in many countries, CREs have become a pressing global concern. In a media briefing last March, U.S. Centers for Disease Control and Prevention president Tom Frieden called CRE a "nightmare bacteria" and said 42 states have had at least a single case.
In Canada, the number of patients with CRE reported to the Public Health Agency of Canada climbed from 51 in 2010 to 96 in 2011, dropping slightly to 81 in 2012.
Those numbers are collected through the Canadian Nosocomial Infection Surveillance Program, which conducts surveillance for hospital-acquired infections in more than 50 hospitals across the country. Since not all hospitals are part of CNISP, the actual number of CRE cases in Canada is likely higher.
Asked if the Fraser Health cases were a wake-up call, Dr. Hoang said the medical community had already been well aware of the threat.
"It is maybe a wake-up call to general health-care professionals who haven't seen CRE in B.C. compared with other provinces and states in North America," she said. "But for those in the field, for microbiologists and infection-control practitioners, it is not a wake-up call, we have been waiting for this to happen."