The federal government is hobbling efforts to control antibiotic-resistant microbes by sitting on reports about bacteria that sicken and kill thousands of Canadians each year, several doctors say.
Infectious disease experts say Ottawa is treating national microbial surveillance reports like “sensitive government documents.” And the doctors are so frustrated, they are releasing the data they can obtain on their own website.
“Otherwise, it’s years before we see it on the federal website,” says Dr. Mark Joffe, president of the Association of Medical Microbiology and Infectious Disease Canada (AMMI), which represents physicians, clinical microbiologists and researchers.
The association has obtained and posted a September 2013 report from the Public Health Agency of Canada on superbugs that infect thousands of patients in Canadian hospitals each, along with a collection of other federal reports on microbes such as carbapenem-resistant organisms, an alarming new breed of bugs that have evolved ways to evade even antibiotics of last resort.
The documents and data on the AMMI website were prepared by the Public Health Agency of Canada but are not available on the federal agency’s website.
The PHAC says Canada has “one of the most advanced and comprehensive systems in the world for tracking antimicrobial resistant organisms.”
The agency works with more than 50 “sentinel” hospitals across the country to collect data on the microbes as part of the Canadian Nosocomial (hospital-acquired) Infection Surveillance Program, known as CNISP. The program is run in collaboration with infectious disease doctors and AMMI.
C Diff cell growth is studied at the National Microbiology Laboratory in the Canadian Science Centre for Human and Animal Health in Winnipeg, Manitoba, Tuesday, August 20, 2013. (John Woods/Postmedia News)
The way the public health agency treats the reports from the surveillance program like “sensitive government documents” is hampering efforts to control the spread of the drug-resistant organisms, says Dr. Lynora Saxinger, at the University of Alberta.
“I can get better access to data from tiny European countries like Estonia on their resistance than I can on trends in Canada,” says Saxinger, who chairs AMMI’s committee on antimicrobial stewardship and resistance.
She and her colleagues say PHAC reports are compiled annually but are not widely shared. The most recent CNISP report on C. difficile, a wily microbe that infects thousands of hospital patients in Canada each year, on the PHAC website is from 2007. And the most recent data on methicillin-resistant Staphylococcus aureus, another potentially lethal pathogen haunting Canadian hospitals, is from 2009.
Such dated information “doesn’t do me a bit of good,” says Joffe, who is also senior medical director of infection prevention and control for Alberta Health Services. “I need to know what is happening today or at least in the last year or so.”
“If you look at the U.K., if you look at the U.S., this kind of information is readily available and is important in trying to control things,” says Joffe. “You can’t do anything about it if you don’t know there is a problem.”
Saxinger says it is “incredibly strange” that the PHAC is sitting on the reports but says this fits with the way the Harper government micromanages information and has been “muzzling” and “gagging” federal researchers.
The public health agency told Postmedia News that “CNISP reports are proactively and regularly shared with all key stakeholders as soon as they are finalized.”
“Additionally, the Agency is currently working to ensure that the most updated information and statistics on antimicrobial resistant organisms is available on its website,” Robert Cyrenne, PHAC communications officer, said in a written response to questions.
In this undated photo provided by the Centers for Disease Control and Prevention is one form of CRE bacteria, sometimes called nightmare bacteria. (AP Photo/CDC)
Saxinger says doctors and hospitals need up-to-date information on resistant microbes circulating in Canada to improve infection control and make appropriate and prudent use of antibiotics. Antibiotics can be lifesaving, but they can also fuel the evolution and proliferation of resistant bacteria that can evade the drugs.
Saxinger says audits indicate between 25 to 50 per cent of the antibiotic used in hospitals is “unnecessary.”
Fifteen PHAC-CNISP reports dated 2011, 2012 and 2013 are now posted on the AMMI website and show how antibiotic-resistant bacteria are morphing and spreading.
The most recent report, dated September 2013, indicates Canada’s efforts to reduce infections with C. difficile, which can caused deadly diarrhea, have stalled.
A hypervirulent strain of C. difficile, first seen when it caused major outbreak in Quebec a decade ago, is now the most common variety of the microbe in Canadian hospitals. There was a slight dip in C. difficile infections and mortality rates in 2009. By 2011, the C. difficile infection and mortality rate climbed back to 2007 levels, according the report.
We all need to be concerned … It’s an ongoing struggle
“We all need to be concerned, there is no question we need to refocus our efforts to try to control C. difficile,” says Joffe, who has been dealing with outbreaks in Alberta. “It’s an ongoing struggle.”
Another report indicates vancomycin-resistant enterococci is spreading rapidly, particularly in western and central Canada. The microbe, which can infect surgical sites, the urinary tract and bloodstream, emerged in Europe and showed up in Canada in 1993.
VRE infection and colonization rates have been “rapidly increasing” with a six-fold increase between 2007 and 2011, the report says. Almost five of every 1,000 patients was colonized by the VRE in 2011.
Fortunately most people do not go on to develop infections, says Joffe. There were 1,241 VRE infections reported to the surveillance network between 1999 and 2011, most of them since 2007.
Joffe says the rising VRE rates point to gaps in infection control. “If you are spreading VRE, it’s probably a marker that other things are being spread too,” says Joffe.
On a more positive note, the reports shows a decline in the health care-associated infections caused by methicillin-resistant Staphylococcus aureus, or MRSA. The bacteria is commonly found on the skin and can cause serious blood, organ and wound infections.
MRSA was first reported in Canada in 1981 and has spread so widely that almost 10 of every 1,000 patients in Canadian hospitals in 2009 was either infected or colonized by the resistant bacteria, the reports show. The total number of hospital acquired MRSA infections dropped almost 25 per cent between 2009 and 2011. But the data show the number of MRSA infections in Canadian communities has been increasing.