Antimicrobial resistance surveillance in Canadian hospitals, 2007-2012

Abstract

Background: The Canadian Nosocomial Infection Surveillance Program (CNISP) is a collaborative effort of the Public Health Agency of Canada's Centre for Communicable Diseases and Infection Control, the National Microbiology Laboratory, and 54 largely university-affiliated tertiary care sentinel hospitals in 10 provinces across Canada.

Objective: To provide a summary of antibiotic resistance rates of four key antibiotic resistant organisms in major hospitals across Canada from January 1, 2007, to December 31, 2012.

Methods: Patients' clinical and demographic data and associated results of laboratory analyses were submitted to the Agency by participating hospitals. The infection rates were summarized per 1,000 patient admissions at national and regional levels.

Results: In Canada, the overall health care-associated Clostridium difficile infection (HA-CDI), HA-CDI rates peaked in 2008 at 5.8 HA-CDI infections per 1,000 patient admissions then remained stable between 2009 and 2012 at approximately 5 HA-CDI infections per 1,000 admissions; the West and Central regions had higher rates than the Eastern region. The rates of methicillin-resistant Staphylococcus aureus (MRSA) peaked in 2009 at 9.5 MRSA infections per 1,000 patient admissions then decreased to 8.8 MRSA infections per 1,000 admissions in 2012, with the Central region having higher rates than the Western and Eastern regions. The rates of vancomycin-resistant Enterococci (VRE), have been low but rising with 0.08 VRE infections per 1,000 patient admissions in 2007, gradually rising to 0.5 VRE infections per 1,000 admissions in 2012, with consistently higher rates in the Western region, slightly lower rates in the Central region and the lowest rates in the Eastern region. The rates of carbapenem-resistant Enterobacteriaceae (CRE) have been measured since 2010 and have been low and stable, with 0.11 CRE infections per 1,000 patient admissions in 2010 and 0.14 CRE infections per 1,000 admissions in 2012, with higher rates in the Western and Central regions and lower rates in the Eastern region.

Conclusion: In Canada, of the four antibiotic resistant organisms under surveillance, HA-CDI and MRSA have been gradually decreasing, VRE is low but rising, and CRE remains low with Western and Central rates consistently higher than Eastern rates.

FIGURE 1. National and regional Health care-associated Clostridium difficile Infection (HA-CDI) incidence rates per 1,000 patient admissions, January 1, 2007 to December 31, 2012. N = 18,871

FIGURE 2. National and regional methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization rates per 1,000 patient admissions, January 1, 2008 to December 31, 2012. N = 9,650

FIGURE 3. National and regional vancomycin-resistant Enterococci (VRE) infection incidence rates per 1,000 patient admissions, January 1, 2007 to December 31, 2011. N = 1,510

FIGURE 4. National and regional carbapenem-resistant Enterobacteriaceae (CRE) rates per 1,000 patient admissions, January 1, 2010 to December 31, 2012. N = 231