The Centre for Disease Control in the U.S. has warned Canadian health authorities about the increase of Carbapenem-resistant Enterobacteriaceae (CRE), a deadly class of superbugs that are resistant to all known antibiotics.
Dr. Marc Romney, a medical microbiologist at St. Paul’s Hospital in Vancouver, said B.C. health authorities are aware of CRE and are taking preventative measures.
Protocols are already in place to try to prevent infected travelers returning from countries such as Greece, Israel, and the Indian subcontinent, where the superbugs are more common, from spreading the superbugs in healthcare facilities here at home.
But, Romney said, it’s only a matter of time before an outbreak of CRE occurs here in B.C.
"Is going to be a big tidal wave or a gradual introduction of cases? Hard to say, but it’s coming."
In B.C., healthcare facilities are using a three-pronged approach to fend off the superbugs: surveillance, screening and prevention.
Extreme caution is used if an ill patient has been treated in a hospital or health-care facility in one of countries where outbreaks of the superbugs were first detected.
This list includes countries such as India, China, Pakistan, Israel and Greece. But more recently, outbreaks have been reported in New York, New Jersey and Montreal.
Other Canadian cities have seen isolated cases but not outbreaks, with British Columbia seeing 30 cases since 2008.
Prevention efforts include asking patients with suspected or diagnosed CRE to stay in their own room and those entering and exiting wear gowns and gloves. Frequent hand washing is also strongly encouraged amongst healthcare professionals.
"At Providence Health Care there will be dedicated specialist physician and pharmacist support to optimize antibiotic prescribing practices," said Dr. Victor Leung, one of the infectious disease physicians spearheading the initiative.
Overprescribing of antibiotics creates superbugs
These bugs are named and defined by their resistance to the Carbapenem class of antibiotics. Unlike previous superbugs, there are no 'last resort' antibiotics after resistance develops and these stop working.
CRE infections can lead to pneumonia, meningitis, wound infections, sepsis and a host of deadly infections.
"CRE are nightmare bacteria," said Dr. Tom Frieden, director of the U.S. Centers for Disease Control.
"Our strongest antibiotics don’t work and patients are left with potentially untreatable infections."
Resistance to antibiotics continues to be an issue worldwide, with overprescribing and overuse of broad-spectrum antibiotics being the main culprits.
In this week’s Lancet magazine, UK's chief medical officer Dame Sally Davis, said that that antibiotic resistance is "as great a threat to our future as terrorism."
That's because routine surgeries, treatments for cancer and autoimmune disease all leave patients vulnerable to superbug infections.
"If we don't take action then we may all be back in an almost 19th century environment where infections kill us as a result of routine operations. We won't be able to do a lot of our cancer treatments or organ transplants," Davis warned.
The problem is that much of the antibiotic resistance occurs in developing countries where antibiotics are readily available, resources scarce and education around resistance non-existent.
“Antibiotic stewardship has to be a global effort in order to make an impact on resistance,” said Romney, the medical microbiologist in Vancouver.
In addition, no new major antibiotics have been made since the late 1980's because antibiotics can have a short lifespan before superbugs become resistant, making them unprofitable for pharmaceutical companies when compared to the other drugs.
But there is hope. Over the last decade, recognition of antibiotic resistance has led to decreased rates of other superbug classes such as Methicillin-resistant staphylococcus aureus (MRSA) in parts of Canada.