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Philippe Martin et al
Table 2. Mean and Median Prevalence of Antibiotic-Resistant Organisms in Adult Inpatients of Canadian Acute-Care Hospitals That Participated in All 3 Surveys (n=106)
hbp
Organism MRSA
2010 Prevalence per 100 Inpatients 2012 Prevalence per 100 Inpatients 2016 Prevalence per 100 Inpatients No. Mean (SD) Median (range) No. Mean (SD) Median (range) No. Mean (SD) Median (range) P Valuea
Colonization or infection 1,124 4.9 (3.7) Infection VRE
127 0.6 (0.9)
Colonization or infection 404 1.6 (2.7) Infection CDI
ESBL
Colonization or infection Infection CRE
Colonization or infection Infection
Not measured Not measured
Not measured Not measured
284 1.2 (1.8) 85 0.4 (0.7)
15 0.05 (0.2) 8 0.03 (0.2)
0.4 (0–8.5) 0 (0–4.0)
0 (0–1.3) 0 (0–1.3)
340b 85b
1.4 (2.0) 0.4 (0.8)
20 0.10 (0.3) 1 0.003 (0.03)
0.8 (0–10.9) 0 (0–5.0)
0 (0–1.6) 0 (0–0.3)
.43 .79
.05 .18
Note. CDI, Clostridium difficile infection; CRE, carbapenem-resistant Enterobacteriaceae, ESBL, extended-spectrum β-lactamase-producing Enterobacteriaceae; MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant Enterococcus. Overall in 2016 survey, 28 patients were infected by both MRSA and CDI, 175 patients were infected by MRSA and VRE, 42 patients were infected by VRE and CDI, and 5 patients were infected
by all 3 AROs. aComparing median prevalence in 2012 with that in 2016. bESBL cases were reported by only 99 hospitals. Data include all cases as defined by each setting.
4.2 (0–14.8) 988 4.7 (3.2) 0.3 (0–5.9)
136 0.6 (0.8)
8 0.05 (0.3) 277 1.0 (1.0)
0.5 (0–13.0) 553 2.2 (2.7) 0 (0–1.8)
0.8 (0–4.3)
4.0 (0–13.9) 0.3 (0–3.3)
13 0.06 (0.2) 329 1.3 (1.2)
1.3 (0–12.7) 0 (0–1.5)
1.0 (0–5.5) 1,032 4.8 (3.4) 137 0.7 (1.0)
560 2.3 (3.9) 9 0.04 (0.2) 283 1.1 (1.0)
4.1 (0–18.5) 0.3 (0–4.5)
0.8 (0–20.5) 0 (0–1.6)
1.1 (0–4.5)
.95 .76
.35 .48 .67
Table 3. Selected VRE Infection and Control Policies Policy
VRE universal or targeted admission screeninga
Additional contact precautions for VRE patients
Note. VRE, vancomycin-resistant Enterococcus. aP<.001.
relatively small number of large tertiary-care hospitals.2 In this study, we aimed to draw a national picture of AROs in Canadian hospitals using a point-prevalence survey in 160 hospitals (representing ~70% of eligible facilities) in 9 of 10 Canadian provinces.
Canadian hospitals, as it is in many countries.8,9 Despite a decrease in healthcare-associated CDI incidence since 2011,2 our survey did not show any difference in the prevalence of CDI among adult inpatients compared to 2010 and 2012. However, more Canadian hospitals are now using commercial nucleic acid amplification tests as part of their algorithm to diagnose CDI. Whether increased use of NAAT increases sensitivity or leads to overdiagnosis10 is not known, but it may mask a decrease in the prevalence of CDI. The prevalence of MRSA did not significantly change from
Clostridium difficile remains the single most frequent ARO in
2010 to 2016. A relatively small proportion of patients (14%) with MRSA were infected, representing a mean MRSA infection
2010 (n=174 hospitals), No. (%) 166 (94)
174 (100)
2012 (n=143 hospitals), No. (%) 127 (89)
137 (96)
2016 (n=160 hospitals), No. (%) 119 (74)
148 (93)
prevalence of 0.7 per 100 inpatients, identical to that observed in the 2012 survey. In comparison, a declining trend in the incidence of MRSA infection has been reported by the Canadian Anti- microbial Resistance Surveillance System, with a decrease of ~25% in MRSA infection rates among hospitalized patients from 2008 to 2014.2 This declining trend in incidence of MRSA healthcare-associated infection has also been reported in the United States.11 Although we used of a broader definition to identify healthcare-associated MRSA infection, the prevalence in Canadian hospitals was lower than that identified in a 2011 multistate point-prevalence survey in US facilities (0.4 per 100 inpatients vs 0.5 per 100 inpatients).8 We did not detect any change in the prevalence of VRE from
2012 to 2016. However, since our previous survey in 2012, a significant number of participating hospitals stopped performing VRE screening on admission, probably due to the burden of VRE management with limited resource for infection control. The true prevalence of VRE colonization in Canadian hospitals is therefore
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