Super-bug infections increasing dramatically

Aggressive action needed to combat the problem, say researchers From Canadian Press Cases of antibiotic resistance in Canada increased sixfold from 1995 to 1999, leaving health-care facilities with a shrinking window of opportunity to keep the potentially life-threatening problem under control, researchers reported Tuesday.

Unless Canada moves quickly and aggressively to combat the problem, rates of resistance in this country will mirror those of the United States - where antibiotic resistance is out of control - within a decade, the authors warn in the Canadian Medical Association Journal.

''It is still not perceived as being a major concern,'' lead author Dr. Andrew Simor said in an interview.

''My concern is if it isn't perceived as being an important health-care issue, it will be too late by the time it's recognized as such.''

Simor and colleagues from the Canadian nosocomial infection surveillance program have been tracking cases of antibiotic resistance in this country since 1995.

Nosocomial means acquired in hospital, which to date is where most Canadians are infected by so-called super bugs. In countries such as the United States, where the problem is more severe, increasing numbers of people are acquiring a bug known as MRSA in the community, a worrying trend.

In the five years from 1995 to 1999, 4,507 Canadian hospital patients were either infected with MRSA - methicillin-resistant Staphylococcus aureus - or were colonized by the super bug.

Studies have shown that between 20 and 40 per cent of people who are colonized - meaning they carry the bacteria in their mucus membranes or on their skin - will go on to become sick with an antibiotic-resistant infection.

Treating such patients is costly and time-consuming. Toronto's Sunnybrook and Women's College Health Sciences Centre, where Simor works, has estimated it costs an extra $14,000 to treat a patient infected with MRSA and an extra $1,360 to treat carriers.

A report published earlier this year in an international medical journal estimated that MRSA is costing Canadian hospitals between $50 million and $60 million a year.

Patients must be isolated from the general hospital population and are generally required to stay in hospital far longer. If they become seriously ill, doctors have few options, generally turning to vancomycin, the antibiotic of last resort.

In countries with severe antibiotic resistance problems, vancomycin resistance also has been reported. And Simor said it's only a matter of time before Canada encounters that problem, too.

''We will see it here sooner or later. Personally, I'd prefer to see it later.''

Dr. Jan Verhoef, an infectious disease specialist from the Netherlands, says Canada must follow the ''seek and destroy'' policies of countries like his own if it wants to keep MRSA under control, especially given the country's proximity to the U.S., where 40 per cent of Staphylococcus aureus strains are resistant.

''Because the rate of MRSA is so much higher in the United States, it would also be advisable for Canadian hospitals to start isolating any patients who are transferring in from U.S. hospitals,'' he wrote in a commentary also published in the journal.

A number of Canadian hospitals do isolate patients coming in from American hospitals until it can be determined whether they have been colonized or infected by MRSA, Simor said. But more must adopt the policy.

''Coming from an American hospital is a major risk factor, not only for MRSA, but indeed for other antibiotic resistant organisms as well,'' said Simor, a medical microbiologist and infectious disease specialist.

Simor said countries like the Netherlands, Denmark and Switzerland have been effective in reducing rates of MRSA through aggressive action and Canada must follow their lead.

''These countries 10 years ago had MRSA rates similar to or even slightly higher than our current rates, but with very aggressive measures have been able to bring those rates down to less than one or two per cent again. And clearly that's the model we should be striving for.

''The problem is that we . . . tend to react when it is a big problem. And clearly what we're interested in is preventing it from becoming a big problem. And the truth is if we do nothing, if we just carry on as we are now . . . in five to 10 years, we will throw up our hands much as the Americans have.''

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-- Martin Thompson (mthom1927@aol.com), July 10, 2001