October 21, 2004
Aaron Derfel and Tom Blackwell, with files from Kevin Dougherty and Leanne Dohey
CanWest News Service and National Post, with files from The Gazette and Calgary Herald
National Post
MONTREAL - Quebec's Health Minister said yesterday a superbug that killed 600 hospital patients in his province last year -- six times the amount previously thought -- is a "scourge" that is proving very difficult to combat.
Philippe Coulliard told a news conference that the dramatic spike in Clostridium difficile infections and deaths, which was revealed in a report by a McGill University microbiologist made public yesterday, is due to a new, highly virulent strain of the bacteria that causes severe diarrhea and, in some cases, death.
"The bacteria may have changed and we may be dealing with a more virulent, active type of microbe than we had before," Mr. Coulliard said.
"Quebec is making every possible effort to limit or even diminish the seriousness of this scourge that is currently affecting our hospitals.''
There have also been limited C. difficile outbreaks in other parts of the country, and health experts warned yesterday an epidemic on the scale of Quebec's could hit elsewhere at any time.
In Quebec, there are usually 4,000 to 5,000 cases of C. difficile per year, or a rate of 10 for every 1,000 patients in hospital. Of those, the death rate has been between 1% and 2%.
But a study by Dr. Vivian Loo of McGill indicates the number of cases rose to 7,000 in 2003, or between 25 and 30 cases for 1,000 patients, and the death rate rose to between 7% and 8%.
Previously, the highest estimate of the death toll from C. difficile in the province's hospitals was close to 100. Dr. Loo's study, conducted in eight Montreal hospitals, did not include the hundreds of patients who have died in Quebec since April, 2004.
Yesterday, Mr. Coulliard urged Quebecers requiring health care to wash their hands to prevent further spread of the illness.
Dr. Jacques Besson, president of the Association to Defend Victims of Nosocomial Infections, accused the government of failing to contain the C. difficile epidemic.
"It's a total abdication of responsibility," said Dr. Besson, a retired allergist who fell ill from C. difficile last year following an operation in a Montreal hospital.
Jean-Pierre Menard, a malpractice lawyer, said he is seriously considering filing a class-action suit against the government after rejecting the idea over the summer.
''I find it extremely worrisome to see to what extent the minister is not in control of the situation,'' Mr. Menard said. ''There are several elements of concern that call into doubt the responsibility of the [Health Department.]''
Dr. Besson contends the government was slow responding to the crisis, that it still has no clear idea of the extent of the epidemic and has not provided hospitals with the funds to reduce the number of infections.
"If these measures had been taken at the beginning, I'm convicned that the great majority of people who died would still be alive today," Dr. Besson said.
Mr. Couillard said the new strain of the bacteria is to blame, not the government. He also said the use of "broad-spectrum" antibiotics, often prescribed before surgery, may be a factor in the spread of the disease, helping C. difficile to become resistant to antibiotics.
The Canadian Public Health Agency is beginning a project Nov. 1 to try to determine the extent of the bacteria, and whether particular strains are to blame for the most severe cases. Reports will be gathered from 21 hospitals across the country.
"Many people are talking about not if it will hit, but when," said Shirley Paton, an expert at the agency on nosocomial -- or hospital-acquired -- illness. Calgary has already had 1,200 cases of C. difficile and 13 deaths since 2001, while three cases were reported in Regina this month.
"I'm just so thankful we don't have what they have," said Dr. Tom Louie, medical director of infection prevention and control for the Calgary Health Region. ''The normal situation with C. difficile is difficult enough."
Dr. Louie said he has spoken with the researchers who conducted the Quebec study, and has been working with them.
In Ontario, infectious disease specialists have conducted a survey that has found some sporadic cases, but nothing like the Quebec epidemic. One hospital in York Region, north of Toronto, has had three deaths this year.
The strains of C. difficile that have caused much of the sickness in Quebec have for the most part not shown up in Ontario, said Dr. Allison McGeer, infection control head at Toronto's Mount Sinai Hospital.
Experts say that may be bad luck on Quebec's part, or possibly because its hospitals use more of the "broad-spectrum" antibiotics.
Regardless, those strains of the bacteria will arrive eventually in other parts of the country, said Dr. McGeer. "It's likely just a matter of time before we see these strains."
Ontario has to do a lot of work to prepare, in infection control and other areas, said Dr. McGeer. Despite the repeated calls for better hygiene after the SARS epidemic, for instance, Ontario hospitals are "nowhere close" to being up to the recommended standard on hand-washing, she said.
Aprovincial Health Ministry advisory committee is planning its own study of the infection, partly to determine whether the reporting of cases to public-health authorities should be made mandatory, said Dan Strasbourg, a ministry spokesman.
The problem in Quebec is "astounding" and so far has not been repeated in Ontario, said Dr. Andrew Simor, chief microbiologist at Toronto's Sunnybrook and Women's Health Sciences Centre. But the province should not expect to be spared, he stressed.
"There is no room for complacency here. We need to be ready."
One concern is the state of infection control at hospitals across the country that have experienced severe budget restraint in recent years, he said.
Ms. Paton said it is up to the provinces initially to make the disease reportable, then the federal government could step in. But reporting rules would probably have to specify the more virulent strains, since there is little point in making hospitals notify authorities of every, minor C. difficile diarrhea case, she said.
CLOSTRIDIUM DIFFICILE
WHAT IS IT?
C. difficile is a common bacteria that is considered the main cause of diarrhea and bowel inflammation after antibiotic use.
WHAT DOES IT DO?
Most patients experience mild diarrhea or inflammation that is easily treated. But there can be severe lower abdominal pain, diarrhea, high fever with chills and rapid heart beat, sometimes culminating in death.
HOW DOES IT WORK?
Attack usually occurs when antibiotic treatment interferes with beneficial bacteria in the bowels, allowing for C. difficile infection, if the bacteria is present in the hospital.
HOW DOES IT SPREAD?
Can be spread by touch and will survive on hospital equipment and other inanimate surfaces for several days.
HOW IS IT TREATED?
Mild cases tend to disappear when the original antibiotic treatment is stopped. More severe cases are treated with other antibiotics --metronidazole or vancomycin.
WHAT'S NEW?
A new study shows that 7,000 people have been infected in Quebec since 1983, four times the rate in previous years, and at least 600 have died.
SOURCE: International Foundation for Functional Gastrointestinal Disorders and The Gazette
Ran with fact box "Clostridium Difficile" which has been appended to the story.
© National Post 2004
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