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Health officials warn hospitals of Afghan bug

Blackadder1916

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Health officials warn hospitals of Afghan bug
Threat posed by highly resistant bacteria underlines lack of preparedness
Tom Blackwell,  National Post 
Published: Wednesday, December 12, 2007

Federal authorities are warning hospitals across the country to beware of a highly drug resistant bacteria that wounded troops are bringing back from Afghanistan -- and that could inadvertently be spread to civilian patients.

The threat posed by the resistant strain of acinetobacter underlines the health care system's general lack of readiness for such emerging infections as they arrive in the country, said a senior Public Health Agency of Canada official.

Several soldiers being treated in civilian hospitals here have already developed pneumonia from the drug-resistant strain of the bacteria, which scientists say likely originated in the Canadian-led trauma centre at Kandahar Air Field.

Hospitals are being advised by the agency to screen injured soldiers for the bug, and take infection-control precautions if they test positive.

No transmission to non-military patients has been detected yet, and the bug is not seen as much of a danger to healthy people outside of hospital. The fear, however, is that the resistant strain could genetically combine with more easily treatable versions of the bacteria that are more common in Canadian intensive-care units, said Shirley Paton of the public-health agency.

"We're seeing a new organism being introduced into the Canadian swamp of organisms, this one being highly resistant," she said.

"If we get someone with this highly resistant strain, are the two bugs going to get together into one? ... We're quite concerned that this will start spreading and become the acinetobacter of choice in the ICUs. We're really worried about that kind of transmission."

Outbreaks that may have originated in soldiers coming from Iraq or Afghanistan have already occurred in U.S. and British hospitals.

It is "critical" that hospital infection-control officers here are aware of the issue and respond appropriately, says a recent article in the Canadian Journal of Infection Control by agency officials and outside experts.

"Ultimately, there is the risk that you end up with a brand of organism that is invulnerable to antibiotics. There is little treatment available," said Dr. Andrew Simor of Toronto's Sunnybrook Health Sciences Centre, one of the country's leading infectious-disease experts. "We have to take that seriously."

The public-health agency is planning a meeting for February or March involving the Department of National Defence, provincial public health departments and major hospitals to discuss the acinetobacter problem, and newly emerged pathogens generally, Ms. Paton said.

"How do we respond to something that is just arriving? Can we track it, can we stop it? Can we hold it? " she asked. "I don't think we have the processes in place yet to really respond in a nice, efficient, everybody-knows-what-they're-doing kind of manner."

Drug-resistant microbes, sometimes called superbugs, have become an increasing anxiety for hospitals in Canada, with the most common of them, Methicillin-resistant staphylococcus aureus (MRSA) being blamed for thousands of deaths a year.

Often found in soil, acinetobacter is a danger to the old and seriously ill, particularly those on breathing machines, causing wound and blood infections and pneumonia. It was detected in many American casualties of the Vietnam war, then arose again in 2003 when U.S. and British doctors started finding it in soldiers returning injured from Iraq and Afghanistan. At least four U.S. troops have died from the infection since then.

Canadian soldiers started testing positive for the bug after their mission in southern Afghanistan began last year. The most seriously wounded are sent to civilian hospitals here for further treatment.

At least 10 with acinetobacter have shown up in ICUs, said Ms. Paton. There have been an unknown number of other "walking wounded" troops with the bug, who have not been admitted to Canadian hospitals but might have visited family physicians or military doctors, she said.

A paper published in the journal BMC Infectious Diseases in August documents the cases of four Canadian soldiers, injured by roadside bombs and other means, who ended up on ventilators in 2006. All developed a pneumonia caused by acinetobacter that was resistant even to the carbapenem class of antibiotics, virtually the last line of defence against the microbe.

Although the paper does not mention the outcome of their cases, Dr. Simor, a co-author of the paper, said he is unaware of any deaths from acinetobacter infection of Canadian combatants.

A investigation by the Defence Department found an identical strain of the bacteria in a ventilator used at the Canadian-managed trauma hospital on Kandahar Air Field, a NATO base, suggesting that is where it originated. Measures have since been taken to try to clear the field hospital of acinetobacter, said Dr. Simor.

Meanwhile, the Forces' health services department has advised families of some returning soldiers to avoid unprotected contact with the soldier until he or she has been screened for acinetobacter, according to an article by three military doctors in a recent issue of Wound Care Canada.


Articles referenced in the above piece are at:
BMC Infectious Diseases - Multi-drug resistant Acinetobacter infections in critically injured Canadian Forces soldiers
Wound Care Canada - Acinetobacter Infections in Wounded Soldiers: Implications for Canadian Hospitals (article available in PDF)
 

Armymedic

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I sat in a symposium period about this.

The NATO medical system can not conclusively prove that this microbe and the infection is cause is exclusive to the OEF and OIF AORs. They have other (mostly US) soldiers whom seem to contract the disease caused by the microbe along the chain of evac.

The best theory is that it is an opportunistic microbe that will only appear in injured tissue where other microbe have been destroyed by antibiotic therapy. There is also no recorded cases of wounded Afghans contracting the infection.

Studies continue.
 

PMedMoe

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Not to mention that more and more microbes, bacteria etc are becoming "drug resistant" due to overuse (and misuse) of antibiotics and antimicrobial/antibacterial products.
 

geo

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Heh.... talk about fighting for your life.

WRT StMike's comment about the Afghans who never contracted the illness... you have to consider that given the sanitary & health conditions in Afghanistan, it's only the strong that survive & thee people have been exposed to so many different bugs in the past that they have become resistant to most of them.

I remember when the DART team went to Pakistan and the engineers set up their ROWPU + started to distribute clean water.  The locals got sick because their system was used to the contaminants in their water & pure clean water was a shock to them.

Who woulda thought ???
 

GAP

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BioMed Central Blog
Thursday Dec 20, 2007
Article Link

Canadian TV provides excellent coverage of open access research on superbug afflicting soliders in Afghanistan

It's always nice to see research from BioMed Central journals covered in the mainstream media, and  Soldiers bringing superbug back from Kandahar from Canadian broadcaster CTV is an excellent example, featuring research recently published by Dr Homer Tsien and colleages in BMC Infectious Diseases.

It is currently the top story on the CTV website, and the story includes a video of the newscast concerned, along with a more in-depth interview with Dr Tsien.

Perhaps most impressively, CTV have done a great job of providing a route for readers to find out more by linking directly to the open access research article concerned. It's surprisingly rare that news outlets provide such links, but kudos to the CTV team for doing so. BioMed Central is working with other news organizations to encourage them to do the same.
More on link
 

geo

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Praise for Cdn MsM? 

Really?

Who woulda thought?

 
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