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http://ca.news.yahoo.com/s/27062006/2/xhealth-dangerous-superbug-taking-canada-moving-beyond-high-risk-groups.html






Dangerous superbug taking off in Canada, moving beyond high-risk groups




Tue Jun 27, 06:52 PM EST




By Helen Branswell
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TORONTO (CP) - A dangerous strain of a superbug that can be caught
outside hospital settings has moved beyond the boundaries of the
high-risk groups it first plagued in Canada, causing illness in healthy
adults and children in a number of provinces across the country,
researchers reported Tuesday.



In a series of articles and commentaries rushed to print by the
Canadian Medical Association Journal, they reported on the spread of
community-acquired methicillin-resistant Staphylococcus aureus - known
in the medical community as CA-MRSA.



The drug-resistant forms of the bug that are spreading in the community
- strains labelled USA300 and USA400 - generally cause hard-to-treat
skin and soft-tissue infections, weeping wounds that will not heal. But
they can also occasionally cause severe illness and even death in
previously healthy individuals.



"It's sweeping across the nation, no doubt about it," said Dr. John
Conly, senior author of one of the papers and a leading researcher on
the scope of Canada's problem with community-acquired MRSA.



"I think this is a pan-Canadian problem."



Historically, infections caused by antibiotic-resistant strains of
Staph aureus were transmitted in hospitals, where the heavy use of
antibiotics has allowed a variety of drug-resistant bacteria to
flourish.



But over the past 10 or 15 years, public health authorities in first
Australia and later the United States and Europe reported the troubling
emergence of a couple of virulent strains of MRSA that seem to have
developed in the community, in people who hadn't been hospitalized.



Some groups in the community have been known to be at high risk - the
homeless or residents of homeless shelters, intravenous drug users,
crack cocaine smokers, prison inmates and men who have sex with men.
Frequent skin-to-skin contact, crowding and suboptimal hygiene are
believed to facilitate the bugs' spread.



But in the United States, where the problem is more advanced than it
has been to date in Canada, infections have been cropping up in
day-care centres and on sports teams, both professional and amateur.



Conly said U.S. public health authorities estimate the case load runs
to the hundreds of thousands.



"Washington, Oregon, California and Texas - they've got 15-,
16-year-olds on ventilators and are seeing really quite devastating
pneumonias as a result," he said from Calgary, where he teaches
medicine at the University of Calgary.



"So this is really quite a serious issue and I think it's an important
one from a standpoint of Canadian physicians to realize that this is
not actually something south of the border but has swept up from the
southwestern United States and is now sweeping across Canada."



Conly, who chairs the Canadian Committee on Antibiotic Resistance, said
Calgary has already seen 300-plus cases of community-acquired MRSA,
including four or five deaths.



And while Calgary's outbreak seemed to predate others in the country,
communities in southwestern British Columbia, Saskatchewan, Manitoba
and beyond are seeing an upswing in cases, he said.



Dr. Allison McGeer, head of infection control at Toronto's Mount Sinai
Hospital, said the problem is being seen in Canada's largest city as
well.



"Where we used to see none a decade ago and one or two a year starting
five years ago, last year there were probably 12 or 15 (cases)," McGeer
said of her hospital alone.



"It's beginning to be a regular feature."

Some of the cases are in people from known high-risk groups; but others
are in patients who have no obvious risk of developing CA-MRSA, she
noted.

In jurisdictions where CA-MRSA has been a problem for a while, the
virulent community strains have started colonizing hospitals, leading
to higher rates of hospital infections and deaths associated with this
superbug.

McGeer expects this to happen in Canada too, saying the drug-resistant
forms of Staph aureus will drive out the easier-to-treat strains that
are susceptible to more antibiotics.

"Eventually it's clear that these strains are going to take over," she
said.

A commentary on the issue insisted, though, that it's too soon to throw
in the towel, calling for a concerted effort to combat the spread of
the superbug.

"Given that MRSA does not respect provincial, territorial or other
jurisdictional boundaries, national collaborative efforts are
required," wrote Dr. Upton Allen, an infectious disease expert at
Toronto's Hospital for Sick Children.

Both Conly and McGeer said it is important for Canadian physicians to
consider CA-MRSA when seeing patients with skin and soft-tissue
infections and to test the wounds for the presence of drug-resistant
microbes, so doctors don't end up treating patients with drugs that
will have no impact.