Antimicrobial Resistance In Canada Research Articles

Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2017-2021.

Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) continue to contribute to excess morbidity and mortality among Canadians. This report describes epidemiologic and laboratory characteristics and trends of HAIs and AMR from 2017 to 2021 (Candida auris 2012-2021) using surveillance and laboratory data submitted by hospitals to the Canadian Nosocomial Infection Surveillance Program (CNISP) and by provincial laboratories to the National Microbiology Laboratory (NML). Data collected from 88 Canadian sentinel acute care hospitals between January 1, 2017, and December 31, 2021, for Clostridioides difficile infections (CDI), carbapenemase-producing Enterobacterales (CPE), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) and vancomycin-resistant Enterococcus (VRE) BSIs. Candida auris (C. auris) surveillance was initiated in 2019 by CNISP and in 2012 by the NML. Case counts, rates, outcomes, molecular characterization and antimicrobial resistance profiles are presented. From 2017 to 2021, increased rates per 10,000 patient days were observed for MRSA BSIs (35%; 0.84-1.13), VRE BSIs (43%; 0.23-0.33) and CPE infections (166%, 0.03-0.08). CDI rates decreased 11% (5.68-5.05). Thirty-one C. auris isolates were identified in Canada from 2012 to 2021, with the majority from Western Canada (68%). From 2017 to 2021, the incidence of MRSA and VRE BSIs, and CPE infections increased in Canadian acute care hospitals participating in a national sentinel network (CNISP) while CDI decreased. Few C. auris isolates were identified from 2012 to 2021. Reporting standardized surveillance data and the consistent application of infection prevention and control practises in acute care hospitals are critical to help decrease the burden of HAIs and AMR in Canada.

Knowledge Gaps in the Understanding of Antimicrobial Resistance in Canada.

Current limitations in the understanding and control of antimicrobial resistance (AMR) in Canada are described through a comprehensive review focusing on: (1) treatment optimization; (2) surveillance of antimicrobial use and AMR; and (3) prevention of transmission of AMR. Without addressing gaps in identified areas, sustained progress in AMR mitigation is unlikely. Expert opinions and perspectives contributed to prioritizing identified gaps. Using Canada as an example, this review emphasizes the importance and necessity of a One Health approach for understanding and mitigating AMR. Specifically, antimicrobial use in human, animal, crop, and environmental sectors cannot be regarded as independent; therefore, a One Health approach is needed in AMR research and understanding, current surveillance efforts, and policy. Discussions regarding addressing described knowledge gaps are separated into four categories: (1) further research; (2) increased capacity/resources; (3) increased prescriber/end-user knowledge; and (4) policy development/enforcement. This review highlights the research and increased capacity and resources to generate new knowledge and implement recommendations needed to address all identified gaps, including economic, social, and environmental considerations. More prescriber/end-user knowledge and policy development/enforcement are needed, but must be informed by realistic recommendations, with input from all relevant stakeholders. For most knowledge gaps, important next steps are uncertain. In conclusion, identified knowledge gaps underlined the need for AMR policy decisions to be considered in a One Health framework, while highlighting critical needs to achieve realistic and meaningful progress.

Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2014-2018.

Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose serious threats to the health of Canadians due to increased morbidity, mortality and healthcare costs. Epidemiologic and laboratory surveillance data, collected through the Canadian Nosocomial Infection Surveillance Program, are used to inform infection prevention and control and antimicrobial stewardship programs and policies. The objective of this study was to describe the epidemiologic and laboratory characteristics and trends of HAIs and AMR from 2014 to 2018 using surveillance data provided by Canadian hospitals participating in the Canadian Nosocomial Infection Surveillance Program. Data were collected from 70 Canadian sentinel hospitals between January 1, 2014 and December 31, 2018 for Clostridioides difficile infection (CDI), methicillin-resistant Staphylococcus aureus bloodstream infections, vancomycin-resistant Enterococci bloodstream infections and carbapenemase-producing Enterobacteriaceae. Case counts, rates, outcome data, molecular characterization and antimicrobial resistance profiles are presented. Additionally, hospital-level Escherichia coli antibiogram data were collected and are described. Increases in rates per 10,000 patient-days were observed for methicillin-resistant S. aureus bloodstream infections (59%; 0.66-1.05, p=0.023) and vancomycin-resistant Enterococci bloodstream infections (143%; 0.14-0.34, p=0.023). However, CDI rates decreased by 12.5% between 2015 and 2018 (from 6.16-5.39, p=0.042). Carbapenemase-producing Enterobacteriaceae infection rates remained low and stable whereas colonization increased by 375% (0.04-0.19; p=0.014). Ongoing efforts to prevent HAIs and reduce AMR in Canada require consistent, standardized surveillance data from acute care hospitals. Increased collaboration with provincial, territorial and international partners in infection prevention and control, as well as antimicrobial stewardship, will be essential in reducing the burden of observed HAIs (including antimicrobial resistant organisms).

Extended-Spectrum β-Lactamase and AmpC β-Lactamase-Producing Escherichia coli Isolates from Chickens Raised in Small Flocks in Ontario, Canada.

Food-producing animals are recognized to play a role in the epidemiology of antimicrobial resistance in Canada. However, the presence of resistant organisms in particular groups of animals, such as chickens raised in small-holder flocks, has not been studied. The purpose of this study was, therefore, to identify and characterize Escherichia coli possessing broad-spectrum β-lactamase genes among a collection of third-generation cephalosporin-resistant isolates recovered from 205 small flocks in southern Ontario. Extended-spectrum β-lactamase (ESBL; CTX-M-1) positive strains were isolated from 26 out of 205 flocks (12.7%), whereas 39 strains possessing AmpC (CMY-2) were grown from 31 out of 205 flocks (15.1%). Pulsed-field gel electrophoresis (PFGE) revealed that the isolates were genetically heterogeneous. Further testing by multi-locus sequence typing confirmed that none of the PFGE-defined clusters belonged to ST131. Our results suggest that the dissemination of this resistance in bacteria isolated from chickens in small-holder flocks may be associated with the spread of plasmids rather than particular E. coli clones and that these isolates do not possess the ESBL types most commonly associated with human infections (CTX-M-15).

Factors potentially linked with the occurrence of antimicrobial resistance in selected bacteria from cattle, chickens and pigs: A scoping review of publications for use in modelling of antimicrobial resistance (IAM.AMR Project).

Antimicrobial resistance is a complex issue with a large volume of published literature, and there is a need for synthesis of primary studies for an integrated understanding of this topic. Our research team aimed to have a more complete understanding of antimicrobial resistance in Canada (IAM.AMR Project) using multiple methods including the literature reviews and quantitative modelling. To accomplish this goal, qualitative features of publications (e.g., geographical location, study population) describing potential relationships between the occurrence of antimicrobial resistance and factors (e.g., antimicrobial use; management system) were of particular interest. The objectives of this review were to (a) describe the available peer-reviewed literature reporting potential relationships between factors and antimicrobial resistance; and (b) to highlight data gaps. A comprehensive literature search and screening were performed to identify studies investigating factors potentially linked with antimicrobial resistance in Campylobacter species, Escherichia coli and Salmonella enterica along the farm-to-fork pathway (farm, abattoir (slaughter houses) and retail meats) for the major Canadian livestock species (beef cattle, broiler chicken and pigs). The literature search returned 14,966 potentially relevant titles and abstracts. Following screening of titles, abstracts and full-text articles, the qualitative features of retained studies (n=28) were extracted. The most common factors identified were antimicrobial use (n=13 studies) and type of farm management system (e.g., antibiotic-free, organic; n=8). Most studies were conducted outside of Canada and involved investigations at the farm level. Identified data gaps included the effect of vaccination, industry-specific factors (e.g., livestock density) and factors at sites other than farm along the agri-food chain. Further investigation of these factors and other relevant industry activities are needed for the development of quantitative models that aim to identify effective interventions to mitigate the occurrence of antimicrobial resistance along the agri-food chain.

What are Canadian primary care physicians prescribing for the treatment of gonorrhea?

Cases of Neisseria gonorrhea are on the rise in Canada, which-if undetected or undertreated-can lead to morbidity and infertility. In addition, the number of antimicrobial resistant strains is also increasing creating the risk that N. gonorrhea may become untreatable. In 2013, the Public Health Agency of Canada (PHAC) released Canadian recommendations for the management and treatment of gonorrhea that identified the need for combination therapy to address and minimize antimicrobial resistance. However, the level of awareness and uptake of these guidelines is not well-known. To assess primary care physicians' prescribing practices for the management and treatment of gonorrhea. After validity testing, two online cross-sectional surveys were conducted with a convenience sample of Canadian physicians. Physicians answered true/false statements and open-ended questions relating to three clinical scenarios: 1) suspected anogenital infection drawing from a population of men who have sex with men (MSM); 2) suspected anogenital infection drawing from a non-MSM population; and, 3) suspected pharyngeal infection drawing from any population. Frequencies of responses were calculated for the statements. Open-ended responses were recoded into treatment categories and frequencies were calculated for each scenario. A total of 625 physicians completed the survey. Most physicians (60%-95%) accurately identified knowledge statements regarding pharmaceutical management, partner notification and public health reporting. For all clinical scenarios, 30%-35% of physicians did not provide any treatment information, approximately 30% indicated treating with cephalosporin monotherapy, 20%-25% indicated they would prescribe a cephalosporin and azithromycin and a minority of physicians identified other treatment options. When physicians were asked about the purpose of the second antibiotic, azithromycin, 49% indicated it was to provide presumptive treatment for gonorrhea and chlamydia. Forty-one percent indicated it was to provide presumptive treatment for chlamydia only. This convenience sample suggests that although knowledge of pharmaceutical management, partner notification, and public health reporting is high, the use of combination therapy to deter the development of antimicrobial resistant gonorrhea may not be widespread among primary care physicians. In light of both the growing incidence of N. gonorrhea and the rising rates of antimicrobial resistance in Canada, consideration on how to improve awareness and update of best prescribing practices in primary care may be indicated.

CIPARS: A One-Health Approach to Antimicrobial Resistance Surveillance

The objective of the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) is to provide a unified approach to monitor national trends in antimicrobial resistance (AMR) and antimicrobial use (AMU) in humans and animals and to facilitate the assessment of the public health impact of antimicrobial use. CIPARS is a combination of passive and active surveillance that is coordinated by the Public Health Agency of Canada (PHAC) but is based on extensive collaborations. Stakeholder engagement has led to action based on surveillance results. This One-Health approach provides a holistic understanding of AMR in Canada and enables the evaluation of interventions.

Antimicrobial resistance and use in Canada: A federal framework for action.

Antimicrobial resistance (AMR) is a serious and growing global public health threat. Modern medical and veterinary practice depends on the widespread availability of effective antimicrobials to prevent and treat infections in humans and animals. Addressing the growing threat of AMR in Canada is a shared responsibility; Antimicrobial Resistance and Use in Canada: A Federal Framework for Action serves as a starting point for a collaborative response. The goal of the Framework is: "To protect Canadians from the health risks related to antimicrobial resistance." It includes three pillars: Surveillance, Stewardship, and Innovation. The Framework identifies concrete Government of Canada actions to reduce the threat and impact of AMR. Equally important, it is a vehicle to engage partners and stakeholders in discussions on efforts that, together, can significantly increase the results of individual actions. Beyond the Government of Canada, provinces and territories, academia, animal and human health professionals, food production stakeholders, animal producer groups and farmers, as well as private industry each hold essential levers to reduce AMR. By continuing to work together, we will collectively achieve greater results in reducing the risks of antimicrobial resistance and protecting the health and safety of all Canadians.

Introduction to the CANWARD study (2007-11)

Antimicrobial resistance is a continuing challenge to the appropriate, timely, cost-effective and ecologically appropriate delivery of antimicrobials. Surveillance studies conducted globally and nationally can assist in determining trends over specific geographical areas and allow comparisons between countries and within very specific infectious processes. CANWARD is an ongoing, national, Health Canada-endorsed, multiyear study focused on both inpatient and outpatient pathogens isolated in Canadian hospitals and determining their degree of antimicrobial resistance, with a particular emphasis on specific wards (medical, surgical, intensive care units, emergency room and clinics) as well as specific infection sites (urine, blood, respiratory and wound). This Supplement documents the initial 5 years of the CANWARD study (2007–11 inclusive). The seven manuscripts in this Supplement provide a comprehensive examination of pathogens covering multiple infectious processes. The data highlight the continued emergence of resistance and should provide to healthcare professionals nationally and globally the current status of antimicrobial resistance in Canada.

Control of antimicrobial resistance in Canada: any lessons to learn?

BackgroundOver the past 15 years, repeated national meetings have developed recommendations for a Canadian antimicrobial resistance strategy. Despite this, in 2011 there is no comprehensive, integrated national program with appropriate governance and funding to address antimicrobial resistance.FindingsThe Public Health Agency of Canada supports a reference laboratory for diagnosis and characterization of selected resistant strains, targeted surveillance programs which monitor resistance trends for selected animal and human organisms, development of national infection control guidelines including for antimicrobial resistant organisms, and a few local pilot projects to address community acquired MRSA. Sporadic programs of variable intensity and quality are supported by some provinces, health regions and individual facilities but these are not comprehensive, standardized or integrated. Individual researchers and research groups, however, have published substantial information describing the prevalence and impact of resistance in Canada.ConclusionsCurrent review of activities by the Public Health Agency of Canada and initiatives by the National Coordinating Centre for Infectious Diseases may move the country forward in developing an effective national approach to address antimicrobial resistance.

Leaked internal report criticizes government oversight of antimicrobial resistance

The federal government’s oversight of antimicrobial resistance is sorely plagued by deficiencies, according to a draft report prepared by officials at the Public Health Agency of Canada (PHAC). The internal government report, Antimicrobial Resistance in Canada: A Gap Analysis , argues that the

Population-Level Interventions to Reduce the Development and Transmission of Community-Associated Antimicrobial Resistance: A Perspective from the National Collaborating Centre for Infectious Diseases

Antimicrobial resistance (AMR) in bacteria is the end result of a multitude of factors. Some of the key factors beyond innate resistance include antimicrobial selective pressure (1–5), acquisition of a foreign genetic resistance element(s) (1–5), clonal dissemination (1) and new mutations (2,3,5); factors vary for different species and geographical locations. Increased global antimicrobial use is the foremost reason for the spread of AMR in the community setting (1). Social networks of individuals (households, schools and child care facilities) have served both as a reservoir for these bacteria and as a common route for their transmission. Similarly, hospitals, nursing homes and long-term care facilities have also served as reservoirs for antibiotic-resistant organisms, and the discharge of patients from these facilities contributes to the spread of resistance within communities. In addition, the use of antimicrobials in food animals has been an important contributing cause (1).

Antimicrobial resistance in Canada: Update on activities of the Canadian committee on Antibiotic Resistance

This article is the first in a planned series of semi-annual updates, intended to provide readers with up-to-date information on antibiotic resistance in Canada and on the many current activities designed to address the problem. This information is provided by the Canadian Committee on Antibiotic Resistance (CCAR), a national organization that has a mandate to coordinate activities designed to address the growing problem of antibiotic resistance in Canada.

Antimicrobial Resistance in Canada: Update on Activities of the Canadian Committee on Antibiotic Resistance

Antimicrobial Resistance in Canada: Update on Activities of the Canadian Committee on Antibiotic Resistance

Antimicrobial Resistance in Canada: Update on Activities of the Canadian Committee on Antibiotic Resistance

Antimicrobial Resistance in Canada: Update on Activities of the Canadian Committee on Antibiotic Resistance

Antimicrobial Resistance in Canada: An Update on Activities of the Canadian Committee on Antibiotic Resistance

This article is the first in a planned series of semi-annual updates, intended to provide readers with up-to-date information on antibiotic resistance in Canada and on the many current activities designed to address the problem. This information is provided by the Canadian Committee on Antibiotic Resistance (CCAR), a national organization that has a mandate to coordinate activities designed to address the growing problem of antibiotic resistance in Canada.

A review of antimicrobial resistance in Canada

Antimicrobial resistance is a global concern. Over the past 10 years, considerable efforts and resources have been expended to detect, monitor, and understand at the basic level the many different facets of emerging and increasing resistance. This review summarizes our current understanding of bacterial antimicrobial resistance issues in Canada with particular emphasis given to the Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus, Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Streptococcus pyogenes. In addition, future concerns and programs for ongoing surveillance are discussed.

Trends in antimicrobial susceptibility of bacterial pathogens isolated from patients with bloodstream infections in the USA, Canada and Latin America

From January through June of 1998, 4579 bloodstream infections (BSI) due to bacterial pathogens were reported from SENTRY hospitals in Canada, the USA and Latin America. Staphylococcus aureus, Escherichia coli, and coagulase-negative staphylococcus (CoNS) were the most common pathogens, together accounting for 55.2% of all BSI during this time period. Compared with the 5794 BSI reported from SENTRY from January through June of 1997, no major change was seen in the frequencies of occurrence of the most common bacterial causes of BSI. Between 1997 and 1998, the major change in antimicrobial resistance was an increase in oxacillin-resistance in both S. aureus and CoNS in all regions. These data demonstrate widespread antimicrobial resistance in Canada, Latin America and the USA, with a notable increase in oxacillin-resistance among staphylococci. Ongoing surveillance remains essential, and will enhance efforts to limit the scope of this worldwide problem.

A review of antimicrobial resistance in Canada

Antimicrobial resistance is a global concern. Over the past 10 years, considerable efforts and resources have been expended to detect, monitor, and understand at the basic level the many different facets of emerging and increasing resistance. This review summarizes our current understanding of bacterial antimicrobial resistance issues in Canada with particular emphasis given to the Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus, Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Streptococcus pyogenes. In addition, future concerns and programs for ongoing surveillance are discussed.