Infection Control & Hospital Epidemiology (2019), 40,53–59 doi:10.1017/ice.2018.279
Original Article
Prevalence of antibiotic-resistant organisms in Canadian Hospitals. Comparison of point-prevalence survey results from 2010, 2012, and 2016
Philippe Martin MD1, Claire Nour Abou Chakra PhD1, Victoria Williams MPH2,3, Kathryn Bush MSc4, Myrna Dyck MSc5, Zahir Hirji MSc6, Alex Kiss PhD7, Oscar E. Larios MD8, Allison McGeer MD3,9, Christine Moore MLT, BSc9,
Karl Weiss MD10, Andrew E. Simor MD2,3 and Infection Prevention and Control Canada 1Department of Microbiology and Infectious Disease, Université de Sherbrooke, Sherbrooke, Quebec, Canada, 2Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada, 3University of Toronto, Toronto, Ontario, Canada, 4Alberta Health Services, Calgary, Alberta, Canada, 5Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada, 6The Scarborough Hospital, Toronto, Ontario, Canada, 7Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada, 8University of Calgary, Calgary, Alberta, Canada, 9Mount Sinai Hospital, Toronto, Ontario, Canada and 10Jewish General Hospital, Montreal, Quebec, Canada
Abstract
Objective: Point-prevalence surveys for infection or colonization with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin- resistant Enterococcus (VRE), extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, carbapenem-resistant Enterobacter- iaceae (CREs), and for Clostridium difficile infection (CDI) were conducted in Canadian hospitals in 2010 and 2012 to better understanding changes in the epidemiology of antimicrobial-resistant organisms (AROs), which is crucial for public health and care management. Methods: A third survey of the same AROs in adult inpatients in Canadian hospitals with ≥50 beds was performed in February 2016. Data on participating hospitals and patient cases were obtained using standard criteria and case definitions. Associations between ARO prevalence and institutional characteristics were assessed using logistic regression models. Results: In total, 160 hospitals from 9 of the 10 provinces with 35,018 adult inpatients participated in the survey. Median prevalence per 100 inpatients was 4.1 for MRSA, 0.8 for VRE, 1.1 for CDI, 0.8 for ESBLs, and 0 for CREs. No significant change occurred compared to 2012. CREs were reported from 24 hospitals (15%) in 2016 compared to 10 hospitals (7%) in 2012. Routine universal or targeted admission screening for VRE decreased from 94% in 2010 to 74% in 2016. Targeted screening for MRSA on admission was associated with a lower prevalence of MRSA infection. Large hospitals (>500 beds) had higher prevalences of CDI. Conclusion: This survey provides national prevalence rates for AROs in Canadian hospitals. Changes in infection control and prevention policies might lead to changes in the epidemiology of AROs and our capacity to detect them.
(Received 9 July 2018; accepted 9 October 2018; electronically published 5 November 2018)
Antimicrobial resistance is a serious threat to global public health.1 Surveillance of colonization and infections is an essential component of any comprehensive program to control anti- microbial resistant organisms (AROs). The Public Health Agency of Canada recently established the Canadian Antimicrobial Resistance Surveillance System (CARSS) as part of their action plan on antimicrobial resistance and use in Canada.2 Although the number of participating hospitals in this program has increased, there are still some important limitations: hospitals are
Author for correspondence: Dr Philippe Martin, Department of Microbiology and
Infectious Diseases–CHUS, 3001, 12ème Avenue Nord, Sherbrooke, Quebec, Canada J1H 5N4. E-mail:
Philippe.Martin@
USherbrooke.ca PREVIOUS PRESENTATION: Preliminary results of this study were presented at the
annual meeting of the Infectious Diseases Society of America, 2016 IDWeek on October 28, 2016, in New Orleans, Louisiana (abstract no. 1491).
Cite this article: Martin P, et al. (2019). Prevalence of antibiotic-resistant organisms in
Canadian Hospitals. Comparison of point-prevalence survey results from 2010, 2012, and 2016. Infection Control & Hospital Epidemiology 2019, 40, 53–59. doi: 10.1017/ice.2018.279
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
predominantly large tertiary-care facilities, and most of the data describe incidence of infections with no information regarding ARO colonization. To address these surveillance gaps, we con- ducted the first national prevalence survey of AROs in a large sample of Canadian hospitals in 2010 with a follow-up survey 2 years later. Targeted AROs included methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enter- ococcus (VRE), extended-spectrum β-lactamase (ESBL)–produ- cing organisms, carbapenem-resistant Enterobacteriaceae (CREs), and Clostridium difficile infection (CDI). While MRSA and CDI prevalences were stable, the prevalence of VRE colonization increased between 2010 and 2012.3 To assess more recent potential changes in the epidemiology of AROs in Canada, we conducted a point-prevalence survey in 2016 targeting the same AROs. We also collected information on selected infection pre- vention and control policies used in Canada hospitals to control AROs to detect identify changes that might potentially impact the epidemiology of these organisms or our capacity to detect them.
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