Health Committee on Dec. 2nd, 2025

[Burton Bailey, Conservative, Red Deer, AB]

Thank you, Madam Chair.

Dr. Elsayed, you briefly spoke about medical tourism and the number of infections we're seeing coming back to Canada. Should we not, as physicians and dentists, be telling patients about the risks of medical tourism?

[Sameer Elsayed]

Madam Chair, certainly, I do try to emphasize the importance of seeking health care within Canada. Even some of my family members have asked about it. They said they're going to wait forever to get surgery and they could get it more quickly if they went to another country. I told them that their risk of getting a post-operative infection with a drug-resistant organism would be far greater if they went to such-and-such a country than if they got their health care in Canada. Even the United States has a higher incidence of antimicrobial resistance compared to Canada.

I would say Canada is [Technical difficulty—Editor] in our health care system to encourage more Canadians—

[Burton Bailey, Conservative, Red Deer, AB]

Thank you so much.

Dr. Wuerz, we've been seeing a very sharp increase in necrotizing fasciitis. I'm wondering if this is due to an improper initial diagnosis. Do you have any thoughts on that?

[Terry Wuerz]

Necrotizing fasciitis, just for information, is the most severe form of skin soft tissue infection that we see. It can be rapidly progressive, has a high mortality rate and requires urgent surgical intervention to improve outcomes.

As for why, it is true that we do see cases coming up. For example, in my home province we have a very high incidence rate of necrotizing fasciitis. The reasons underlying that are not entirely clear. This is not necessarily driven by antimicrobial resistance per se, but when we do see infections that are of that nature and severity that are caused by antimicrobial resistant organisms, the results are devastating because we don't have the time to wait days to get the infection under control.

[Burton Bailey, Conservative, Red Deer, AB]

Thank you.

This leads me to another question and I'd like your thoughts on it.

With some provinces enabling safe injection sites, we're seeing so many more needle injection injuries that require IV antibiotics. When IV antibiotics aren't effective, sometimes it turns into necrotizing fasciitis. We're seeing some of the vulnerable population losing limbs. I heard you speaking about how debridement and amputation are the options.

I am wondering whether it is possible that in the emergency rooms we're misdiagnosing some of the vulnerable people or whether it is just how aggressive necrotizing fasciitis is.

[Terry Wuerz]

I really appreciate that question, because the topic of infections related to injection drug sites is very near and dear to my heart.

I would propose that it's a combination of the factors the member brought forward. We are seeing many infections that are presenting late related to injection drug site infections, and that certainly contributes to the problem. In some cases, I'm sure it has happened that they are vulnerable individuals who have a hard time advocating for their health, so they may have initially been misdiagnosed. This continues to be a major problem that requires prevention as well as good, appropriate and timely access to treatments.

[Burton Bailey, Conservative, Red Deer, AB]

Thank you, Doctor.

[The Chair, Liberal, Hedy Fry]

You have 45 seconds.

[Burton Bailey, Conservative, Red Deer, AB]

Madam Chair, at this this time, I'd like to move a motion, which was put on notice on Friday, November 28. All members should already have it, in both official languages. Would you like me to read the motion, Madam Chair?

[The Chair, Liberal, Hedy Fry]

Is it pertaining to the agenda, the subject that we're dealing with today?

[Burton Bailey, Conservative, Red Deer, AB]

It was tabled and reads:

That the committee invite the Minister of Health and department officials to appear to testify on the supplementary estimates (B) on December 4, 2025 or December 9, 2025.

[The Chair, Liberal, Hedy Fry]

Witnesses, please excuse us while we deal with the motion on the floor.

Does anyone wish to speak to the motion?

Go ahead, Mr. Mazier.

[Dan Mazier, Conservative, Riding Mountain, MB]

Madam Chair, can we seek unanimous consent on this? It's been tabled. We all would like to have the minister come in next week.

[The Chair, Liberal, Hedy Fry]

Do we have unanimous consent?

[Some hon. members]

Agreed.

[The Chair, Liberal, Hedy Fry]

(Motion agreed to)

That has been dealt with, so I'll go to Ms. Jaczek for the Liberals.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Thank you so much, Madam Chair.

Many of the witnesses today talked about national surveillance. There are models. It seems like many recommendations have been made to include other sites for surveillance, such as long-term care, community and so on. I'm all in favour of data, but the next step is stewardship. I would like to dig a bit into that.

We have some data from 2023 that shows there was only a 6.6% decrease in annual antimicrobial prescribing compared to 2019. In other words, presumably, stewardship efforts are having some impact, but it's not exactly a dramatic decrease.

Perhaps, Dr. Wuerz, you could start off by describing what comprises the stewardship program and how you try to avoid the inappropriate use of antibiotics, either the dosage or a particular compound. Presumably, education is key in this, but how do you see this rolling out? How could we make it more effective compared to the rather small decrease that we've seen to date?

[Terry Wuerz]

The honourable member is absolutely right. Antimicrobial stewardship is a program that is designed to improve antibiotic prescribing, getting the right drug to the patient at the right dose and duration. This requires a multi-faceted approach, so it's really a quality improvement program.

We have different tools to address that. Probably the most effective one is something we call audit and feedback. This is where cases where antimicrobials are being used, especially in those cases in the hospital setting where there's really a need to review the antibiotic, the antimicrobial stewardship team, which is a team of pharmacists and physicians, will go to the patient, review the case and apply the most relevant evidence and guidelines to improve the antibiotic prescription. Really, they are offering a recommendation to the treating physician. This has a benefit of not only improving the situation for the patient but also, over time, changing the culture by really bringing that evidence at the level of patient and prescriber. That's one tool. It's called audit and feedback.

Education plays a huge role. That is not enough by itself. We need to have the boots on the ground to provide that antimicrobial stewardship.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Do you see those boots on the ground being comprised of the infection control practitioner who is in the hospital? We're talking about the acute care setting in this instance, of course. In Ontario, we have—or we had—a very strong system of infection control practitioners in each acute care facility. Would they not be vital as part of the team?

[Terry Wuerz]

I agree that infection prevention and control are a vital resource. They are present in hospitals. They have a very strong overlapping role within an antimicrobial stewardship team, but antimicrobial stewardship teams have a slightly different focus. It's really to bring the best antibiotic recommendations to the patient, not just prevention and control. In most cases, an antimicrobial stewardship team is run by pharmacy, whereas IPAC teams are more led by nurses supported by their physician leaders. They're all leaders, but yes, they work together.

[The Chair, Liberal, Hedy Fry]

You have one minute.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

In the old days, when I practised medicine, which was a long time ago, we used to wait for the Gram stain, the culture, to come back from the lab before we prescribed. Has that gone out the window, so to speak? Patients seem to be requesting antibiotics for whatever ails them. Are we not waiting for at least some lab results?

[Terry Wuerz]

The practice of medicine hasn't changed so drastically since the honourable member has practised. It depends. It depends on the severity of infection and how long we can wait to prescribe an antibiotic. In some cases, we're seeing patients with sepsis or a severe, life-threatening infection where we do need to prescribe an empiric antibiotic before we obtain the culture results, which can take, as you say, a day or more than a day. It really depends. In less dire situations, it's still absolutely recommended to wait for the culture.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

I'll now go to the next questioner.

Ms. Larouche, you have the floor for two and a half minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Madam Chair.

Mr. Wuerz, do you share the Auditor General's opinion about the lack of data on vulnerable populations in certain geographic areas? How does that impact antimicrobial resistance?