Continuing our World Antibiotic Awareness Week blitz, let’s head back to the 2017 Canadian Antimicrobial Resistance Surveillance System report

Carbapenase-producing Enterobacteriaceae (CPE) are Gram negative bacteria (e..g E. coli, Klebsiella, Enterobacter) that are resistant to carbapenems, an important class of antibiotics. They’re a big concern because carbapenems are used for people with serious infections, and treatment options may be limited (since these strains are often resistant to many other drug classes too). Carbapenems aren’t used in food animals and are rarely used in companion animals, but resistance can be found in bacteria from animals. It’s probably driven by use of other antibiotic classes that are used in food animals that CPE are also resistant to. A big issue is that these bacteria are common inhabitants of the gut. Therefore, resistant strains can live happily in the intestinal tract for potentially long period of time, being passed in feces. (I probably don’t need to point out that cows poop a lot).

In Canada, screening of farm, slaughterhouse and retail samples was started in 2013, with a new technique added in 2016 to provide more sensitive detection.

  • The good news….no CPE were identified amongst over 13,000 screened surveillance isolates.
  • The somewhat concerning news….9/3,000 farm/retail/slaughterhouse samples were positive. That’s obviously a low rate but it’s not zero. All were seafood products. Three are stated as being imported, while my assumption is the other 6 were too (although I could be wrong…it’s not clear in the report). This highlights the fact that we don’t live in a bubble and bacteria could case less about immigration rules.

The fact that no CPE were identified in livestock or their associated products was great.

For now, at least.

It will probably happen but continued surveillance to identify and hopefully mitigate risks like this is important. We’re also continuing to look for CPE in companion animals. I’ve dealt with a few cases, but all were from the US. CPE in pets may end up similar to the situation with MRSA, whereby infections in pets are most often associated with transmission from infected owners, but food animals, food and the environment all remain potential ways that CPE could be spread from livestock.

At this point, CPE is rare in people in the community, but if it successfully spills out into the community from hospitals, we’ll likely see further spillover into domestic animals. Yet another reason why a multisector approach to antimicrobial stewardship is needed (yes, that’s a plug for CANresist, but it’s true).

JSW

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