Abstract
BackgroundAntimicrobial resistance is a growing threat to the world’s ability to prevent and treat infections. Links between quantitative antibiotic use and the emergence of bacterial resistance are well documented. This study presents benchmark antimicrobial use (AMU) rates for inpatient adult populations in acute-care hospitals across Canada.MethodsIn this retrospective surveillance study, acute-care adult hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) submitted annual AMU data on all systemic antimicrobials from 2009 to 2016. Information specific to intensive care units (ICUs) and non-ICU wards were available for 2014–2016. Data were analyzed using defined daily doses (DDD) per 1000 patient days (DDD/1000pd).ResultsBetween 2009 and 2016, 16–18 CNISP adult hospitals participated each year and provided their AMU data (22 hospitals participated in ≥1 year of surveillance; 11 in all years). From 2009 to 2016, there was a significant reduction in use (12%) (from 654 to 573 DDD/1000pd, p = 0.03). Fluoroquinolones accounted for the majority of this decrease (47% reduction in combined oral and intravenous use, from 129 to 68 DDD/1000pd, p < 0.002). The top five antimicrobials used in 2016 were cefazolin (78 DDD/1000pd), piperacillin-tazobactam (53 DDD/1000pd), ceftriaxone (49 DDD/1000pd), vancomycin (combined oral and intravenous use was 44 DDD/1000pd; 7% of vancomycin use was oral), and ciprofloxacin (combined oral and intravenous use: 42 DDD/1000pd). Among the top 10 antimicrobials used in 2016, ciprofloxacin and metronidazole use decreased significantly between 2009 and 2016 by 46% (p = 0.002) and 26% (p = 0.002) respectively. Ceftriaxone (85% increase, p = 0.0008) and oral amoxicillin-clavulanate (140% increase, p < 0.0001) use increased significantly but contributed only a small component (8.6 and 5.0%, respectively) of overall use.ConclusionsThis study represents the largest collection of dispensed antimicrobial use data among inpatients in Canada to date. Between 2009 and 2016, there was a significant 12% decrease in AMU, driven primarily by a 47% decrease in fluoroquinolone use. Modest absolute increases in parenteral ceftriaxone and oral amoxicillin-clavulanate use were noted but contributed a small amount of total AMU. Ongoing national surveillance is crucial for establishing benchmarks and antimicrobial stewardship guidelines.
Highlights
Antimicrobial resistance is a growing threat to the world’s ability to prevent and treat infections
Ongoing national surveillance is crucial for establishing benchmarks and antimicrobial stewardship guidelines
Between 2009 and 2016, between 16 and 18 Canadian Nosocomial Infection Surveillance Program (CNISP) adult hospitals per year provided antimicrobial use (AMU) data, with representation from 6 sites in western Canada, 15 in central Canada (Ontario/Quebec), and 1 in eastern Canada
Summary
Antimicrobial resistance is a growing threat to the world’s ability to prevent and treat infections. Links between quantitative antibiotic use and the emergence of bacterial resistance are well documented. Antimicrobial resistance (AMR) is a serious and growing worldwide threat to our ability to prevent and treat infections. The link between quantitative antibiotic use and the subsequent emergence of bacterial resistance is well documented [6]. Antimicrobial stewardship, which aims to optimize the appropriate indication, selection, dosing, route, and duration of antimicrobial therapy, is an important component of reducing overall antibiotic use and has been shown to improve patient safety [7]. Effective antimicrobial stewardship and comprehensive infection prevention and control programs have potential to limit the emergence and spread of AMR [8,9,10].
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