Health committee  I think the challenge with CARSS, although it's a very good initial step, is that it's not comprehensive and does not feel the pulse of all the places where health care is being delivered. Not only do we need to know about teaching hospitals where there's a problem, but we also need to know where there's no problem so that we're not wasting resources where there is no problem.

Health committee  I'll give you the example of children with an ear infection in the Netherlands and the Nordic countries.

Health committee  They are observed for 48 hours before giving them antibiotics. In Canada, however, the reflex is to give them antibiotics because an ear infection can sometimes cause meningitis, and the infection, if undiagnosed, can lead to many long-term complications. To avoid a single possible case of harmful complications, a hundred people are treated with antibiotics.

Health committee  It could have an effect. I read the record of the testimonies of people from the veterinarian society who appeared before the committee. They said that it wasn't common here and that veterinarians avoided using antibiotics without a good reason. According to these testimonies, they aren't used for growth, but only to prevent or treat infections.

Health committee  Sometimes there is no vaccination against a given infection. I'm thinking of bacterial infections in hospitalized patients. We don't yet have a vaccination against the harmful pathogens I've described.

Health committee  First of all, we need a good monitoring system. It all starts with that. Right now, we don't have the numbers that would indicate where we're at. The second challenge is the fact that we are a litigious society. Many of those who consult a doctor don't want to argue with the doctor about what to do.

Health committee  We haven't progressed much in the federal system either. We have good labs that collect good data. We have some community labs, private labs, that publish resistance rates, like LifeLabs in Ontario, but we don't have a national clearing house, which should also have local data, because we can't use just national data.

Health committee  This old wives' tale, if I can call it that, has been somewhat demystified in the last year—the idea that when you get an antibiotic course, you have to finish it. You have to take the whole course. We now know there is no evidence for that, and people are encouraging shorter-course regimens, as Dr.

Health committee  In that case I was referring to community-associated MRSA. It really hasn't changed much, now that you raise it. People know it's out there. They'll have their own experience as physicians in obtaining a culture and seeing there's a bit of drug resistance out there. What they don't know is, a priori, if I have a patient in front of me, what's the probability that they have a drug-resistant infection?

Health committee  There is truth to the link between farm use of antibiotics for animal husbandry purposes and drug resistance, but I don't think it applies so much to Canada. In Europe it was definitely observed, especially with the emergence of vancomycin-resistant enterococci, which, as it turns out, is not as important a bug right now in terms of having a drug discovery void, where we don't have anything left to treat people with.

Health committee  I don't want this to turn into airport screening. That's for sure, and I will say that at the outset, but there is a form of screening we are doing for hospital-admitted patients who fit certain risk factors. It is not simply visitors. It's true that visitors who come into the hospital, who walk in, might have a drug-resistant bug on them, but they're not necessarily transmitting infections.

Health committee  First of all, Kuwait has a big drug resistance problem, in part because drugs have been overused, and it's the same thing on the Indian subcontinent. You even have antibiotics ending up in fresh water that people are consuming. This is one of the big risks when antibiotics-laden effluent from manufacturers ends up in the sewage.

Health committee  I'll answer that first, but I'm sure Dr. Shevchuk will have other comments. I sat on the committee to evaluate drugs for Ontario. It oversees the Ontario drug benefit formulary, so I'm quite aware of this problem. I'll speak a bit to procalcitonin testing, which is not something that's readily available in Canada.

Health committee  Thank you very much for your time and attention.

Health committee  The so-called “superbugs” that we should be worried about are almost all Gram-negative bugs. This is where we have the shortage of antibiotics. We've run out of oral antibiotics in many cases, as I cited. The high-priority bugs are generally food safety issues. If we have a good food safety process, you're not going to get salmonella.