Patients isolated after drug-resistant bacteria outbreak

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Health authorities have stepped up a fight against a drug-resistant family of bacteria that has spread among a small number of patients in one unit at Royal Columbian Hospital in New Westminster.

The Fraser Health Authority officially declared an outbreak on Monday, isolating patients in the ward and requiring medical staff to be gowned and gloved.

The problem at Royal Columbian was initially seen as part of a cluster of cases in the region. But the status was escalated to "outbreak" when infection prevention and control measures at the hospital failed to stop the bacteria from spreading.

Health officials said in a statement that "because of sustained transmission of the bacteria on this unit, we are now declaring an outbreak and have implemented further measures."

The bacteria – Carbapenemase-producing enterobacteriaceae, or CPE – is of growing concern around the world because it is resistant to most antibiotics. The U.S. Centers for Disease Control has described it as "a serious threat to public health," and it has become widely referred to as the "nightmare bacteria" because it is so difficult to knock out.

Elizabeth Brodkin, executive medical director for infection prevention and control at Fraser Health, said five patients are known to be carrying CPE at Royal Columbian. That is down from a total of 10, all on the same medicine unit, but concerns increased because the bacteria were persisting. "I believe it is in a decline stage, but we want to see a really good decline before we say the outbreak is over and this is taken care of," she said in an interview on Monday.

"We had been following this unit for a few weeks and had control measures in place," she said. "But [we] made a decision late last week that the rate of decline was not as quick as we would like to have seen and therefore it was time to formally declare an outbreak."

Of the 10 patients detected with CPE in the unit, five have left the hospital.

"Actually, most of them didn't need to be treated because they weren't infected," Dr. Brodkin said. "They were colonized or carriers. They were in hospital for other unrelated reasons and those conditions were managed and they went home."

Between July and the end of last year, the Fraser Health Authority detected 41 cases of CPE, but most of those people were carriers who did not have infections.

That cluster was of concern, but was not alarming, Dr. Brodkin said, because of the demographics of the region. CPE is common in Asia, in some countries in Europe and some U.S. states.

"Our health authority serves a population that is strongly linked to a number of parts of the world where these bacteria are very common. And so we see patients coming and going from our sites every day who are colonized," she said.

She said health concerns arise when patients with the bacteria become infected and doctors have to find a drug or combination of drugs to treat it.

"Most patients who have this bacteria are colonized, which means they are completely asymptomatic and not made ill by it," Dr. Brodkin said. "But if a patient becomes infected, the symptoms they get depends on where the infection is. It could be a bladder infection, it could be a lung infection, it could be a bloodstream infection. And … so the specific antibiotics that are required might vary from case to case. So every infected case is managed by an infectious disease physician who looks at the infection, who looks at the bacteria and decides what antibiotics are most likely to be effective."

Dr. Brodkin said the fight to control the outbreak is likely to last several weeks.

"It will be at least a month and perhaps longer than that before we will be comfortable saying this outbreak is over," she said, explaining that it takes time to screen for CPE and then do the laboratory work necessary to understand how cases are linked.

Authorities are telling Vancouver-area residents to be vigilant about hand-washing as they work to contain an outbreak of CPE at Royal Columbian Hospital (full story). Here, Dr. Elizabeth Brodkin answers questions about the bacteria.