Superbugs slipping through ‘gaps’ and ‘loopholes’ in Canadian regulations

Electron microscope image of a C. difficile producing a spore.  PHOTO: DAVID GOUDLING

Electron microscope image of a C. difficile producing a spore.

Published: February 20, 2014

Canada needs to better control and contain resistant microbes — or superbugs — that are killing and sickening thousands of Canadian each year, say leading doctors.

A good place to start, they say, is to close “loopholes” that permit Canadian farmers to import antibiotics by the truckload to feed to their animals – a practice that helps breed resistant microbes.

The doctors say the Harper government also needs to file gaps in oversight and provide much more “timely” surveillance reports on the resistant microbes found not only in Canadian health-care facilities but farmyards and meat counters.

The lack of a Canadian action plan is “an international embarrassment,” Dr. John Conly, medical director of infection prevention and control at the Foothills Medical Centre in Calgary, told a Senate committee in Ottawa last week.

Antibiotics can be lifesaving, but the drugs have also fuelled the rise of resistant bacteria that can evade the drugs.


This is a slide showing Klebsiella pneumoniae bacteria growing on a culture plate. K. pneumoniae containing the dangerous NDM-1 gene were behind recent hospital outbreaks reported by two hospitals in the Toronto region. NDM-1 renders multiple types of bacteria resistant to most antibiotic, making infections caused by them almost impossible to treat. THE CANADIAN PRESS/HO-US Centers for Disease Control

Resistant organisms now cause about 2,000 deaths a year in Canada, Dr. David Patrick, of the B.C. Centre for Disease Control, told the Senate committee.

“But the deaths are the tip of the iceberg,” Patrick said, noting that tens of thousands of Canadians are also sickened each year.

Resistant gonorrhea is now common, skin infections and abscesses are becoming increasing resistant and difficult to treat, as are common urinary infections.

A new breed of microbe, known as carbapenem resistant enterobacteriaceae  (CRE), is even more alarming. These so-called “nightmare” bacteria have the biochemical machinery to withstand nearly all antibiotics on the shelf.

They are spreading around the world and while still rare in Canada, they have shown up in Ontario, Quebec, Alberta and, most recently, caused an outbreak in B.C.

CRE can be deadly. They also readily share their genes for resistance with common bacteria living in people’s guts raising fears that many everyday infections could soon be untreatable.

The World Health Organization has called for countries to step up surveillance of resistance microbes and cut unnecessary use of antibiotics.

Conly, Patrick and many of their infectious disease colleagues are frustrated by Canada’s muted response.

The Public Health Agency of Canada said in 2009 it was working on a “coherent path forward to address antimicrobial resistance in Canada.”

It has yet to deliver on that pledge or many other “empty promises,” Conly said in an interview this week.

“Canada is an international embarrassment with its lack of a coordinated action plan,” said Conly. His report to the Senate lays out the details.

Conly says much should be done to reduce misuse of antibiotics in both health care and farming, estimating that at least 40 per cent of  current use is unnecessary.

Agriculture is by far the bigger consumer, using about eight times more antibiotics “by weight” than the medical system, said Patrick.

The drugs are added to food and water in a bid to try boost growth of chickens, pigs and cattle. Antibiotics are also used to prevent and treat infections that can spread quickly on farms with hundreds of animals living in close quarters.

The agricultural use breeds resistant microbes that the doctors say can – and do —  move from farm to fork.

“We see drug resistant bacteria on Canadian meat, we see drug resistant bacteria coming through the food chain and causing infections in humans,” Patrick told the Senate, pointing to data from on microbes found on farms, in slaughterhouses and meat sold in Canadian stores.

He and his colleagues at Association of Medical Microbiology and Infectious Disease Canada will release a detailed report this spring on the state of antimicrobial stewardship in Canada.

The Harper government’s “communication apparatus” so tightly controls information, it can take  “years’” for the Public Heath Agency of Canada to release surveillance reports on resistant microbes.

Patrick said there are gaps in several areas, and a clear need for better monitoring and control of antibiotics on Canadian farms.

“In agriculture we have a black hole,” said Patrick. With the exception of a few sectors, like B.C. aquaculture that voluntarily tracks antibiotics use, “we have no picture of who is using antibiotics for what.”

Canada’s agricultural use is now “virtually untrackable,” he said, because of  “loopholes” in federal regulations that permit farmers to import antibiotics by the truckload for use on their own farms – loopholes that the doctors want closed.

The Public Health Agency of Canada appears to be in no hurry to close them. “The ability to import veterinary drugs for “own use” or “personal use” is built into the regulations for veterinary drugs,” Robert Cyrenne, a PHAC communications officer, said in an email Thursday.

He said antibiotic resistance is a “complex issue” and the PHAC is working to “encourage the careful use of antibiotics by health-care professionals, pharmacists, patients, farmers, veterinarians and food producers.”

The agency does concede there is room for improvement, with Cyrenne saying PHAC is “reviewing approaches to enhance” surveillance of resistant microbes.

He also said PHAC “is committed to sharing surveillance information in an open and transparent way to support the medical community.”

The doctors would like to see the government demonstrate the commitment by providing more “timely” data on resistant microbes circulating in Canada – information Patrick said can be invaluable when trying to tailor treatments and reduce antibiotic overuse.

But the Harper government’s “communication apparatus” so tightly controls information that Patrick noted it can take  “years’” for the Public Heath Agency of Canada to release surveillance reports on resistant microbes.

The data is “not political,” Patrick said, and needs to be made public much more quickly: “It’s information for action, bought and paid for by Canadians.”



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