TROOPS BRING BUG TO CANADA

Hospitals Warned; Drug-resistant bacterium coming from Afghanistan

Tom Blackwell, National Post
Published: Thursday, December 13, 2007


Federal authorities are warning hospitals across the country to beware a highly drug-resistant bacterium that wounded troops are bringing back from Afghanistan -- and which could inadvertently be spread to civilian patients.

The threat posed by the resistant strain of acinetobacter underlines the health care system's general lack of readiness for such emerging infections as they arrive in the country, said a senior Public Health Agency of Canada official.

Several soldiers being treated in civilian hospitals here have already developed pneumonia from the drug-resistant strain of the bacterium, which scientists say likely originated in the Canadian-led trauma centre at Kandahar Air Field.

Hospitals are being advised by the agency to screen injured soldiers for the bug, and take infection-control precautions if they test positive.

No transmission to nonmilitary patients has yet been detected, and the bug is not seen as much of a danger to healthy people outside of hospital. The fear, however, is that the resistant strain could genetically combine with more easily treatable versions of the bacterium that are more common in Canadian intensive-care units, said Shirley Paton of the public health agency.

"We're seeing a new organism being introduced into the Canadian swamp of organisms, this one being highly resistant," she said. "If we get someone with this highly resistant strain, are the two bugs going to get together into one? ... We're quite concerned that this will start spreading and become the acinetobacter of choice in the ICUs. We're really worried about that kind of transmission."

Outbreaks that may have originated in soldiers coming from Iraq or Afghanistan have already occurred in U.S. and British hospitals.

It is "critical" that hospital infection-control officers here are aware of the issue and respond appropriately, says a recent article in the Canadian Journal of Infection Control by agency officials and outside experts.

"Ultimately, there is the risk that you end up with a brand of organism that is invulnerable to antibiotics. There is little treatment available," said Dr. Andrew Simor of Toronto's Sunnybrook Health Sciences Centre, one of the country's leading infectious-disease experts. "We have to take that seriously."

The public health agency is planning a meeting for February or March involving the Department of National Defence, provincial public health departments and major hospitals to discuss the acinetobacter problem, and newly emerged pathogens generally, Ms. Paton said.

"How do we respond to something that is just arriving? Can we track it, can we stop it? Can we hold it?" she asked. "I don't think we have the processes in place yet to really respond in a nice, efficient, everybody-knows-what-they're-doing kind of manner."

Drug-resistant microbes, sometimes called superbugs, have become an increasing cause for anxiety in Canadian hospitals, with the most common of them, Methicillin-resistant staphylococcus aureus (MRSA) being blamed for thousands of deaths a year.

Often found in soil, acinetobacter is a danger to the old and seriously ill, particularly those on breathing machines, causing wound and blood infections and pneumonia. It was detected in many American casualties of the Vietnam war, then arose again in 2003 when U.S. and British

doctors started finding it in soldiers returning injured from Iraq and Afghanistan. At least four U.S. troops have died from the infection since then.

Canadian soldiers started testing positive for the bug after their mission in southern Afghanistan began last year. The most seriously wounded are sent to civilian hospitals here for further treatment.

At least 10 with acinetobacter have shown up in ICUs, Ms. Paton said. There have been an unknown number of other "walking wounded" troops with the bug, who have not been admitted to hospitals but might have visited family physicians or military doctors, she said.

A paper published in the journal BMC Infectious Diseases in August documents the cases of four Canadian soldiers, injured by roadside bombs and other means, who ended up on ventilators in 2006. All developed a pneumonia caused by acinetobacter that was resistant even to the carbapenem class of antibiotics, virtually the last line of defence against the microbe.

Although the paper does not mention the outcomes of their cases, Dr. Simor, a co-author of the paper, said he is unaware of any deaths from acinetobacter infection of Canadian combatants.

An investigation by the Defence Department found an identical strain of the bacteria in a ventilator used at the Canadian-managed trauma hospital on Kandahar Air Field, a NATO base, suggesting that is where it originated. Measures have since been taken to try to clear the field hospital of acinetobacter, Dr. Simor said.

Meanwhile, the Forces' health services department has advised families of some returning soldiers to avoid unprotected contact with the soldier until he or she has been screened for acinetobacter, according to an article by three military doctors in a recent issue of Wound Care Canada.