Infection Control & Hospital Epidemiology
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Fig. 1. Median (range) prevalence (per 100 inpatients) of methicillin-resistant Staphylococcus aureus (MRSA, colonized or infected cases), vancomycin-resistant Enterococcus (VRE), Clostridium difficile infection, extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL) and carbapenem-resistant Enterobacteriaceae (CRE). Legend: Eastern Canada: Newfoundland and Labrador, Nova Scotia, New Brunswick. Central Canada: Quebec, Ontario. Western Canada: Manitoba, Saskatchewan, Alberta, British Columbia.
Overall, 106 hospitals participated in all 3 point-prevalence
surveys (2010, 2012, and 2016). Mean and median prevalences of MRSA, VRE, and CDI in these hospitals are summarized in Table 2. No significant changes were detected from 2012 to 2016 in the prevalence of any of the AROs. All participating hospitals reported conducting either universal
or targeted screening for MRSA, most often (93%) using chro- mogenic agar media. VRE infection prevention and control practices changed since 2010 (Table 3). In 2010, all but 1 hospital performed universal or targeted screening compared to 90% in 2012 and 78% in 2016 (P < .001). Also, 7% of hospitals reported not placing VRE patients under additional precautions (ie, con- tact precautions) if VRE was identified in a clinical specimen. Nucleic acid amplification testing had been used in 76% of par- ticipating hospitals as part of the diagnosis algorithm for C. difficile detection compared to 49% in 2012 and 9% in 2010. Only 27% of hospitals screened for ESBLs and 29% of participants did not place ESBL patients in additional (contact) precautions if the ARO was identified in a clinical specimen. High-risk patients were screened for rectal carriage of CREs on admission in 61% of hospitals. The total number of patients that were under additional precautions for any reason on the day of their survey was pro- vided by 114 hospitals: 61% of these patients (n=1,983 of 3,225) were isolated for at least 1 ARO. Crude and adjusted models of hospitals characteristics asso- ciated with ARO prevalence are shown in Table 4 and in the
Appendix. Overall prevalence of MRSA (colonization or infec- tion) was not associated with the number of beds nor with occupancy rate on the day of the survey (Table 4). MRSA pre- valence was higher in settings offering hemodialysis but lower in settings offering care for burns, chemotherapy, and long-term care. Targeted screening (Appendix-Table 2) was associated with higher MRSA prevalence in the adjusted model than universal screening but was associated with lower MRSA infection pre- valence (Table 4). Routine MRSA decolonization was expectedly associated with a lower MRSA prevalence. CDI prevalence was associated with few hospital criteria. The CDI was higher in larger settings (≥200 beds) but decreased in settings with burn and chemotherapy units. Increasing attributed time of infection pre- vention and control personnel did not seem to have a positive effect in reducing the prevalence of MRSA nor of CDI, but it was associated with a decrease in VRE prevalence.
Discussion
Canada and the United States recently released national action plans for reducing antimicrobial resistance.6,7 Both plans emphasize the importance of surveillance to identify new threats or changing patterns in antimicrobial resistance. Despite growing efforts to improve surveillance, most of the data on ARO in Canadian hospitals are incidence data provided to CARSS by a
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