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Monday, 29 August 2011

Superbugs – Canadian superheroes, then a national shame

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There are three good reasons why public health will be an enduring vocation;  Humans continue to innovate and create new technologies which have potential harmful effects; Humans are capable of choosing, and sometimes do not make the healthiest choices; and germs that can make humans sick evolve very quickly.
Things that we can’t see, hear, touch, smell or taste, and have the potential to make us very sick are very capable of instilling disabling fear.   Relatively normal people become walking phobias.  You may have had a sense of the fear during pandemic influenza fears, SARS, or some new emerging organism that you don’t know enough.   Topping the list of dreaded bugs are the aptly names superbugs. 
The job of a microorganism, just as all species,  is to survive and multiple.  The strength of their success is in shear numbers.   Their key to survival are creative ways of adapting to their environment.  When you take an antibiotic for some infection, the drugs often effectively kill off most of the invading bacteria and allow your body the chance to finish off the job.   In its efforts to survive, bacteria and viruses can adapt to the changed environment – one now designed to kill it – by some simple tricks for survival.  First is that while the process of multiplying through cell division is superb – it is not perfect.  Small errors in replication called mutations, can provide a daughter cell with differing characteristics.  Mutated cells that survive better in a hostile environment, can carry this mutation into their daughters as well – merely survival of the fittest. 
In a second common method for developing protection, bacteria that are already able to survive because of existing protection, may merge some of their protection with different bacterial species endowing them with already effective protective mechanisms. 
As such, some bacteria have developed a series of mutations or shared solutions that lead to resistance to some antibiotics – those that have adapted to almost all the weapons in the human arsenal have become dubbed “superbugs”.
While man has been creative in developing new antibiotics, the germs seem to have responded in an even faster fashion.
Canada and most countries have developed national responses to antimicrobial resistance.  Canadian integrated program for antimicrobial resistance surveillance.  One can glance through annual reports and quickly note that the focus is on the agri-food sector specifically.   The Canadian Committee on Antimicrobial Resistance which led the Canadian charge for the late 90’s and early 2000’s, was disbanded in 2009 through a lack of funding.   CCAR obituary  The Canadian Bacterial Surveillance Network is still active but seems to have  fallen off in activity CSBN however does provide antimicrobial resistance patterns through 2009.  Likewise the industry finance National Information Program on Antibiotics fell to the side in about 2004 though the website remains alive NIPA .   Just try to find recent data on antimicrobial use in Canada - please post the link if you do.  The data are owned by a private consortium and the inaccessability of drug use data at a national level is another national shame. 
In 1996, the visionary leadership of Dr. John Conly led Canada on a great success story that has gone untold.  For about 10 years, Canada successfully resisted antimicrobial resistance.  Inappropriate prescribing practices were reduced and antimicrobial stewardship became a professional standard.   Most importantly, the rates of superbug infections in Canada stayed much lower than our neighbours to the south.  While not formally analyzed, the costs savings to the Canadian health care system would be in the hundred’s of millions of dollars.  
But, as is typical in Canada, money saved through public health efforts is not counted as a success. The collective efforts of the organizations have fallen out into the shadows.  Despite assurances from the Public Health Agency of Canada that antimicrobial resistance “coordination at the federal level would be better suited to move this complex issue forward”, the issue remains without a home and without a plan.   Not surprisingly, the superbugs are marching forward relentlessly and Canadian rates have been climbing. 
And who says bugs aren’t smart?  Though perhaps it doesn’t take much brains to outsmart some governments.

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