British Columbia

'We're holding up a floodgate': B.C. fights off superbugs brought home by medical tourists

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2 patients at New Westminster hospital confirmed as carriers of drug-resistant yeast

Anyone who has surgery abroad needs to inform a health-care practitioner in B.C., so checks for drug-resistant infections can be done, a health official says. (Shuttershock)

The risks involved in medical tourism aren't just personal. Having surgery abroad could also mean bringing back a drug-resistant superbug and putting people in this country at risk, B.C. officials warn.

That alert comes after the recent discovery that two patients at New Westminster's Royal Columbian Hospital had been colonized with the multidrug-resistant yeast Candida auris. Though neither patient is infected with the bug, the two join just a handful of cases that have been identified in B.C. since 2017.

Dr. Linda Hoang, medical co-director for the Provincial Infection Control Network (PICNet), said most of these cases have come from travellers who have had treatment overseas, including medical tourists.

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It means patients need to do serious research on the facilities they're considering for surgeries or other treatments abroad, including looking for objective information about the presence of any drug-resistant microorganisms.

"It's not only a problem in India or Southeast Asia. It is endemic in parts of the U.S. and parts of Europe," Hoang told CBC News.

"It [antibiotic-resistant superbugs] is a global problem, and the only way to to be aware of them is to make sure that health-care professionals are informed and our residents are informed when they're seeking health care outside of British Columbia."

It's a sobering reminder for those who travel abroad for medical treatments, whether it's to skip the surgery wait list in B.C., access therapies that aren't approved in Canada or save money on cosmetic therapy. Some of the top destinations for medical tourists from around the world include India, Mexico, Southeast Asia, Brazil and Turkey, according to the Medical Tourism Association.

But facilities in other countries can sometimes take a more haphazard approach to prescribing antibiotics, and overuse can trigger the evolution of resistance to these crucial drugs.

India a major source of bug

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The two colonized patients at Royal Columbian were isolated after the bug was discovered, and the hospital has been aggressively cleaning all areas they had visited, using UV light for disinfection, according to Fraser Health.

C. auris was first identified in Japan in 2009, but it has popped up since then in countries around the world.

It acts much like any other yeast species, causing infections in wounds, the bloodstream and the ears, but the real problem is how to treat it.

"The only real reason why we're concerned or interested in monitoring Candida auris is because of that potential resistance profile, making it difficult to treat with the anti-fungal agent that we have," Hoang said.

The biggest risk of infection right now seems to come from Indian facilities, Hoang said.

A microscopic image, at left, shows Candida auris cells. At right is a culture of the yeast in a petri dish. (The Journal of Infection in Developing Countries)

The bug was confirmed for the first time in B.C. in July 2017 in a patient who'd been treated in India. As it turned out, that traveller also came back with infections from multiple other drug-resistant organisms.

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B.C. doesn't track whether infected people travelled abroad as medical tourists or simply required medical treatment because of an emergency during their voyages.

But patients who have had medical treatment outside B.C. for any reason are a major source of these superbugs, she said.

They include so-called CPOs — carbapenemase-producing organisms like Klebsiella, E. coli and Pseudomonas that have become resistant to broad-spectrum antibiotics, which Hoang describes as the "last resort" for treatment.

In 2017-2018, PICNet recorded more CPO cases than ever before, and more than half of them were from people who had accessed health care overseas, Hoang said.

'There's only so much we can do'

The key for anyone who chooses to have surgery abroad —​ and anyone who needs medical attention while travelling —​ is to let your B.C. doctor know when you return. That way, the doctor can check you for any drug-resistant bugs you may have picked up and give you the appropriate medication if you get sick.

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Being open with that information protects everyone around you.

"If you require health care in British Columbia, you are running the risk of spreading that into our facilities. And that's not a good thing for your neighbouring patients, who might be very sick and vulnerable," Hoang said.

She said B.C. is aggressively monitoring returning travellers for drug-resistant superbugs, but the real key to stopping their spread will be eliminating the excessive use of antibiotics that allows these micro-organisms to evolve resistance.

"We're basically holding up a floodgate, and unless the problems are addressed in these countries where antibiotics are used with minimal regulation and control, there's only so much we can do," Hoang said.