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Drug-resistant germ spreads across B.C.: Sometimes deadly bacteria once confined to hospitals

An alarming explosion in superbugs that used to be acquired almost exclusively by hospital patients is now striking B.C. children and adults.

The newly emerging pattern of antibiotic-resistant bacterial infections known as MRSA (methicillin-resistant staphylococcus aureus), often start as skin infections that progress to boils, impetigo, wound infections, and in extreme cases, invasive blood and lung infections. Their incidence has prompted the B.C. Centre for Disease Control to urge doctors to follow new guidelines for managing patients with suspected infections.

"It is clear that community-acquired MRSA is now being seen across B.C. and that there has been a marked increase in infection over the past year or so," says a recent report of a committee of microbiologists and infectious disease experts, chaired by Dr. David Patrick, head of epidemiology at the centre for disease control.

"Community-acquired MRSA was considered rare in B.C. as recently as 2000 but appears to have emerged quickly over the past 12 to 24 months," adds the report by two dozen experts.

About 30 per cent of people carry the staph aureus bacteria on their skin, which has many subtypes. It continually multiples and evolves into new strains that are able to evade various antibiotics. When it causes serious infections that are typed as a strain resistant to many, but not yet all, antibiotics, it is crucial doctors waste little time matching the right antibiotic bomb to the isolated superbug strain.

During the past decade, several B.C. hospitals have had to close beds and units to contain outbreaks and to quarantine patients with such infections. In 2002, several babies in the special care unit at B.C. Children's Hospital tested positive for MRSA that was thought to have been brought in by either visiting relatives or a newborn who contracted it from the mother.

The centre for disease control recommendations for doctors, including ensuring that blood tests are done and abscesses are drained and then cultured in a laboratory so the proper antibiotics are used, are expected to be posted for family doctors online in the B.C. Medical Journal today. As well, public health officials meeting in Victoria next week will be pressed by the centre for disease control to make MRSA a reportable disease so it can be monitored more closely.

Because antibiotic resistance is thought to be growing as a result of antibiotic overuse, individuals should refrain from using antibacterial soaps in the home. And doctors are being urged not to give in to patients' requests for such medications in uncomplicated, localized skin infections which should instead be treated with hot compresses.

Doctors who suspect more widespread infection in patients with such symptoms as skin infections, body aches and fever should be sure to refer them to specialists after draining lesions and doing swabs.

Because of the fact that MRSA is not yet a reportable disease, province-wide numbers are unavailable, but Patrick expects B.C. will make it reportable "because we need the big picture and we can only get it by following surveillance patterns."

The report shows how quickly events are changing around the province, with these scenarios described by Patrick and his committee:

- At Vancouver General Hospital, the proportion of MRSA infections acquired in the community, not in the hospital, jumped from only one per cent in 2001 to 25 per cent in 2005.

- In a batch of 160 MRSA-isolated samples from communities including Sechelt, Penticton, Prince George and Victoria, 50 per cent of cases were acquired in the community, not in a hospital.

- A private laboratory found that antibiotic-resistant strains doubled between 2000 and 2003.

- In the Lower Mainland, about nine per cent of such isolates are now MRSA but specimens from an inner city medical clinic serving the Downtown Eastside has found that more than half of such infections are MRSA and that a third of wound infections at the clinic are caused by MRSA.

In hospitals, antibiotic-resistant organisms are usually spread on the germ-contaminated hands of doctors, nurses and other heath care providers who are being reminded to wear gloves and to ensure that contaminated surfaces (office furniture and stethoscopes) are cleaned with disinfectants.

In a separate B.C. Medical Journal article, microbiologist Dr. Nevio Cimolai documents the cases of 15 Fraser Valley MRSA infections in patients who attended a medical clinic over a three-year period from 2002 to 2005.

The case series shows that aggressive infections in patients without risk factors are becoming more common, said Cimolai, who is described as a microbiologist at Children's and Women's Hospitals but, while technically still an unpaid employee during still-pending legal proceedings, he was suspended by the hospital five years ago for being rude to his medical colleagues.

Cimolai did not respond to an interview request, but in his article, he said hospitals have historically been "hotbeds of infection . . . [that] have thereafter served as reservoirs for community-acquired infection.

"Patients with risk factors for MRSA infection have then acted as vectors to reintroduce infection back into health care centres. Strategies to reduce MRSA in both hospitals and the community are critical."

Of the 15 patients (none of whom died) whom Cimolai describes, infections occurred in various places such as hands and arms, nasal passages, buttocks, breasts and legs. Seven had infections associated with drug use (sharing dirty needles), one patient became infected as a result of a violent attack by a drug user, two got it from exposure to family or friends who had been in a health care facility and five patients, including two of three infected children, had no apparent risk factors.

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