“Something must be done quickly”

Of the hundred people infected in the last year by the deadly bacteria which is spreading rapidly in Quebec hospitals, around ten have died. Effective treatments are rare, and above all, they are very difficult to obtain in Canada.

“When it infects a person, we have very few choices to treat it. It’s quite worrying,” says the D^re Judith Fafard, director of the Quebec Public Health Laboratory.

Hidden in sinks, healthcare equipment and hospital counters, the bacteria nicknamed BGNPC (carbapenemase-producing Gram-negative bacilli) is particularly insidious. It can settle discreetly in the digestive tract of patients, often without causing the slightest symptom. At this stage, the patient is said to be colonized by the bacteria.

But a catheter-related wound, surgery or a weakened immune system can turn a silent colonization into a severe infection. The bacteria is then likely to invade the tissues and trigger various infections, such as pneumonia, abscesses or urinary infections.

Therefore, time is of the essence: if the bacteria causes septic shock – an abnormal reaction to an infection that can cause certain organs to fail – treatment must be administered in less than two hours to maximize the patient’s chances of survival. said the D^r Yves Longtin, infectious disease microbiologist at the Jewish General Hospital. Septic shock is an abnormal reaction to an infection that can cause certain organs to fail. The patient’s life may be in danger and care must be provided quickly.

This is quite a challenge, since the bacteria is very resistant to antibiotics and the treatments that could overcome it are difficult to access in Canada (see following text). “It’s a challenge,” admits the D^re Theresa Tam, Chief Public Health Officer of Canada, in interview with The Press.

Antibiotic resistance develops when bacteria adapt to the use of drugs. This is a natural process, but one that is intensifying due to human activity, particularly due to the overconsumption of antibiotics.

“Antimicrobial resistance may not seem as urgent as a pandemic, but it is just as dangerous,” said the head of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, in 2020.

A spread that is gaining momentum

Every year, the spread of the BGNPC bacteria increases in the province, mainly affecting hospitals. Nearly two out of three hospitals in Quebec have reported at least one patient carrying this bacteria in the past year.

“We need to do something quickly,” said Dr.^r Yves Longtin, from the Jewish General Hospital.

During the year 2023-2024, 1,259 Quebecers were found to carry the bacteria and 99 were infected. The infected patients ranged in age from 4 days to 104 years. More than one in ten lost their lives.

People infected with the bacteria are usually hospitalized patients who have weakened immune systems, have been treated repeatedly with antibiotics, or have undergone major surgery.

Of those carrying the bacteria, 95% will never contract an infection and will not even realize it. “Their body will get rid of it naturally,” says the D^r Longtin.

The University of Montreal Hospital Center (CHUM) has recorded the highest number of cases of the bacteria, with 18 infections and 156 carrier patients.

The CHUM says it is “taking the situation seriously to ensure safe, quality care and services” to patients. The facility applies various prevention measures, such as rapid patient screening, antibiotic management, cleaning of spaces and medical equipment, and testing of drains and sinks.

Four establishments recorded three cases of infections, namely the Maisonneuve-Rosemont hospital, the Chicoutimi Hospital, the Hôtel-Dieu de Québec and the Verdun Hospital.

Countries around the world are concerned about the progression of BGNPC.

As early as 2009, the WHO described these bacteria as a serious threat to public health.

Cases have already been reported in every US state. In 2017, these bacteria were even the cause of around 13,000 infections in hospitalized patients and around 1,100 deaths in our southern neighbors.

Bacteria in sinks

The bacteria can be transmitted in particular by caregivers and shared equipment. “The main route of transmission between patients remains contact via the hands of health care workers,” said Rébecca Guénard-Chouinard, executive advisor for media relations at CHUM.

The pipes and plumbing of health establishments, however, seem to play a significant role.

The bacteria is found in drains when biological fluids from colonized patients are discharged. When health professionals then pour nutrients, such as solutes or force-feeding, down the sink, they encourage colonization.

“Once it’s down the drain, [les bactéries] walk around the rooms,” explained retired infectious disease microbiologist Marie Gourdeau, during an annual public health day dedicated to BGNPC at the beginning of December.

Patients can then be contaminated by droplets, faucets or healthcare equipment. “Drains do not explain all cases, but it has a significant contribution,” emphasizes Marie Gourdeau.

To reduce the transmission of these bacteria, staff should be trained to dispose of bodily fluids, leftover feeding tubes, and intravenous fluids down the toilet or into an approved device and not into the patient room sink. .