Abstract
ObjectiveIntegrated surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) across One Health sectors is critically important for effective, evidence-based policy, stewardship, and control of AMR. Our objective was to evaluate progress towards achieving comprehensive, integrated AMR/AMU surveillance in Canada.Materials and methodsBased on an environmental scan, interviews of subject matter experts, and reports from the 2014 National Collaborating Centre for Infectious Diseases and the 2016 Canadian Council of Chief Veterinary Officers, we identified 8 core surveillance requirements and their specific components; the latter were assessed using a 2-way classification matrix, with 7 common elements ranked according to development stage.ResultsComponents that mapped to requirements of a comprehensive, fully integrated AMR/AMU surveillance system were mostly in the lowest stages of development (Exploration or Program Adoption). However, both the establishment of the Canadian AMR Surveillance System integrated reporting and expansion of existing components under the Canadian Nosocomial Infection Surveillance Program and the Canadian Integrated Program for AMR Surveillance are improvements. Regardless, obvious gaps in Canadian AMR/AMU surveillance prevent this from being a comprehensive and integrated One Health program.ConclusionAction is needed in 3 crucial areas: i) development of a complete, integrated AMR/AMU surveillance program, based on current success; ii) changes in Federal/Provincial/Territorial policies to require standardized AMR/AMU reporting; and iii) more resources for AMR/AMU surveillance (dedicated persons, funding, and enabling structures and policy). There is an urgent need for prioritization by Federal/Provincial/Territorial governments to address governance, leadership, and funding to create surveillance systems that inform stewardship and policy.
Highlights
According to the World Health Organization, antimicrobial resistance (AMR) threatens global health security (World Health Organization, 2015)
Robust surveillance of resistant organisms and antimicrobial use (AMU) across One Health sectors is needed for effective, evidence-based policy, stewardship, and control measures in the complex interconnections among humans, animals, and the environment (World Health Organization, 2015)
Subject matter experts on human and animal AMR/AMU in Canada were identified, based on involvement in programs/projects related to AMR/AMU surveillance with the National Collaborating Centre for Infectious Diseases (NCCID) and from Canadian professional networks and contacts with the authors
Summary
According to the World Health Organization, antimicrobial resistance (AMR) threatens global health security (World Health Organization, 2015). The Canadian Nosocomial Infection Surveillance Program (CNISP) (IPAC, 2020) and the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) (Government of Canada, 2020a), assemble data on resistant human nosocomial pathogens, zoonotic foodborne pathogens, and elements of AMU in both humans and animals. These programs provide valuable data, there are gaps in data comprehensiveness and quality (Casey, 2018; Grant et al, 2014). A lack of nationallevel program integration stems from challenges in sharing data, inconsistent data collection, analysis, and reporting, and limitations regarding support and infrastructure (Casey, 2018)
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