OFFICIALS DIFFER ON HOW TO FIGHT NEW E. COLI

Drug-resistant strains: Health Canada study
says opinions vary considerably

Tom Blackwell
National Post

Friday, August 30, 2002

New strains of antibiotic-resistant E. coli pose a major health threat but the people charged with combatting outbreaks of the potentially deadly illness cannot agree on how to fight them, says a new study by Health Canada.

It uncovered broad disagreement on the topic among Ontario and Quebec hospital officials, some of whom were worried about the expense of tactics to curb the spread of the bacteria.

Partly in response to the findings, Health Canada is launching a project to develop clear guidelines on how to deal with one of a growing number of drug-resistant disease menaces.

"Future efforts are urgently required to address these issues ... in order to develop a consistent and effective approach," says the study, published recently in Communicable Disease Report, a Health Canada publication.

"The increase in ESBL-mediated resistance amongst E. coli and Klebsiella isolates worldwide makes this a major public health threat."

ESBL is an enzyme which, when attached to E. coli and Klebsiella, a bacteria that can cause pneumonia and other conditions, makes them resistant to a wide range of antibiotics.

Eight elderly people at nursing homes in the Toronto area died due to infections related to an outbreak of ESBL-related E. coli over the last two years.

The study does not refer to the virulent organism, known as E. coli 0157, that killed seven people and sickened thousands of others in Walkerton, Ont. The E. coli in question actually occurs naturally in the gut, but when it migrates to other areas, such as the bladder, blood and wounds, it can make patients seriously ill.

Several standard drugs are rendered useless by the resistant organisms. Other antibiotics can still be used. But they tend to be the most powerful and expensive drugs, and often have to be administered intravenously, which makes hospital admission more likely, said Donna Reynolds, associate medical officer of health for Durham Region, who contributed to the study.

Researchers from the microbiology department of Toronto's Mount Sinai Hospital surveyed infection control officials at 20 major hospitals across Ontario and three in Quebec about how they would deal with outbreaks of the resistant E. coli and Klebsiella bacteria.

Their opinions varied considerably on basic issues, such as the need for precautions among those in contact with the infected patients and whether the patients should be isolated.

Asked about a hypothetical outbreak at a nursing home, all the officials agreed special measures were called for, but "a wide variety of approaches were selected," the study said.

The infection control experts were worried about increasing drug resistance through the spread of the ESBL bugs, but also were concerned about the cost of efforts to halt the spread, the researchers found.

The findings are a concern, said Dr. Mike Mulvey, a Health Canada expert on disease outbreaks in hospitals.

The department is now designing a study to look at different infection-control practices and risk factors related to ESBL bugs that should result in new guidelines to help health officials, he said.

"You're limiting the number of antibiotics you can use to treat the patient and, if it's a serious infection, that can cause problems," he said of the resistant bacteria.

"We certainly don't want it spreading through our hospitals."