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. 2020 Feb 13;9(1):32.
doi: 10.1186/s13756-020-0684-2.

Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016

Wallis Rudnick  1 , Michelle Science  2 , Daniel J G Thirion  3   4 , Kahina Abdesselam  1 , Kelly B Choi  1 , Linda Pelude  1 , Kanchana Amaratunga  1   5 , Jeannette L Comeau  6   7 , Bruce Dalton  8 , Johan Delport  9 , Rita Dhami  9   10   11 , Joanne Embree  12   13   14 , Yannick Émond  15 , Gerald Evans  16 , Charles Frenette  4 , Susan Fryters  17 , Greg German  18 , Jennifer M Grant  19 , Jennifer Happe  20 , Kevin Katz  21 , Pamela Kibsey  22 , Justin Kosar  23 , Joanne M Langley  6   7 , Bonita E Lee  24   25 , Marie-Astrid Lefebvre  4 , Jerome A Leis  26 , Allison McGeer  27   28   29 , Heather L Neville  30 , Andrew Simor  28   31 , Kathryn Slayter  6 , Kathryn N Suh  5 , Alena Tse-Chang  24   25 , Karl Weiss  32 , John Conly  33   34 ; Canadian Nosocomial Infection Surveillance Program
Affiliations

Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016

Wallis Rudnick et al. Antimicrob Resist Infect Control. .

Abstract

Background: 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. This study presents benchmark antimicrobial use (AMU) rates for inpatient adult populations in acute-care hospitals across Canada.

Methods: In 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).

Results: Between 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.

Conclusions: This 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.

Keywords: Antimicrobial use; Hospital; Surveillance.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Total rate of antimicrobials used among adult inpatients at CNISP hospitals with 95% confidence intervals, 2009–2016
Fig. 2
Fig. 2
Total rate of antimicrobial classes/subclasses used among adult inpatients with 95% confidence intervals (2009–2016, top classes/subclasses in 2016)
Fig. 3
Fig. 3
Total rate of antimicrobials used among adult inpatients with 95% confidence intervals (2009 to 2016, top antimicrobials in 2016)
Fig. 4
Fig. 4
Total rate of antimicrobials used by adult inpatients by wardtype with 95% confidence intervals (n = 14–15 hospitals/year)
See this image and copyright information in PMC

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