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Mitchell R, Taylor G, Rudnick W, Alexandre S, Bush K, Forrester L, Frenette C, Granfield B, Gravel-Tropper D, Happe J, John M, Lavallee C, McGeer A, Mertz D, Pelude L, Science M, Simor A, Smith S, Suh KN, Vayalumkal J, Wong A, Amaratunga K. Trends in health care-associated infections in acute care hospitals in Canada: an analysis of repeated point-prevalence surveys. CMAJ 2020; 191:E981-E988. [PMID: 31501180 DOI: 10.1503/cmaj.190361] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Health care-associated infections are a common cause of patient morbidity and mortality. We sought to describe the trends in these infections in acute care hospitals, using data from 3 national point-prevalence surveys. METHODS The Canadian Nosocomial Infection Surveillance Program (CNISP) conducted descriptive point-prevalence surveys to assess the burden of health care-associated infections on a single day in February of 2002, 2009 and 2017. Surveyed infections included urinary tract infection, pneumonia, Clostridioides difficile infection, infection at surgical sites and bloodstream infections. We compared the prevalence of infection across the survey years and considered the contribution of antimicrobial-resistant organisms as a cause of these infections. RESULTS We surveyed 28 of 33 (response rate 84.8%) CNISP hospitals (6747 patients) in 2002, 39 of 55 (response rate 71.0%) hospitals (8902 patients) in 2009 and 47 of 66 (response rate 71.2%) hospitals (9929 patients) in 2017. The prevalence of patients with at least 1 health care-associated infection increased from 9.9% in 2002 (95% confidence interval [CI] 8.4%-11.5%) to 11.3% in 2009 (95% CI 9.4%-13.5%), and then declined to 7.9% in 2017 (95% CI 6.8%-9.0%). In 2017, device-associated infections accounted for 35.6% of all health care-associated infections. Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 3.9% of all organisms identified from 2002 to 2017; other antibiotic-resistant organisms were uncommon causes of infection for all survey years. INTERPRETATION In CNISP hospitals, there was a decline in the prevalence of health care-associated infection in 2017 compared with previous surveys. However, strategies to prevent infections associated with medical devices should be developed. Apart from MRSA, few infections were caused by antibiotic-resistant organisms.
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Affiliation(s)
- Robyn Mitchell
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Geoffrey Taylor
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask.
| | - Wallis Rudnick
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Stephanie Alexandre
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Kathryn Bush
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Leslie Forrester
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Charles Frenette
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Bonny Granfield
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Denise Gravel-Tropper
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Jennifer Happe
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Michael John
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Christian Lavallee
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Allison McGeer
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Dominik Mertz
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Linda Pelude
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Michelle Science
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Andrew Simor
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Stephanie Smith
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Kathryn N Suh
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Joseph Vayalumkal
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Alice Wong
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
| | - Kanchana Amaratunga
- Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask
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Rudnick W, Science M, Thirion DJG, Abdesselam K, Choi KB, Pelude L, Amaratunga K, Comeau JL, Dalton B, Delport J, Dhami R, Embree J, Émond Y, Evans G, Frenette C, Fryters S, German G, Grant JM, Happe J, Katz K, Kibsey P, Kosar J, Langley JM, Lee BE, Lefebvre MA, Leis JA, McGeer A, Neville HL, Simor A, Slayter K, Suh KN, Tse-Chang A, Weiss K, Conly J. Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016. Antimicrob Resist Infect Control 2020; 9:32. [PMID: 32054539 PMCID: PMC7020554 DOI: 10.1186/s13756-020-0684-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/23/2020] [Indexed: 12/29/2022] Open
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.
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Affiliation(s)
- Wallis Rudnick
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
| | | | - Daniel J. G. Thirion
- Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4 Canada
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC H4A 3J1 Canada
| | - Kahina Abdesselam
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
| | - Kelly B. Choi
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
| | - Linda Pelude
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
| | - Kanchana Amaratunga
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON K1H 8L6 Canada
| | - Jeannette L. Comeau
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
- Dalhousie University, 6299 South St, Halifax, NS B3H 4R2 Canada
| | - Bruce Dalton
- Alberta Health Services, 1620 29 St NW, Calgary, AB T2N 4L7 Canada
| | - Johan Delport
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9 Canada
| | - Rita Dhami
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9 Canada
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1 Canada
- University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Joanne Embree
- University of Manitoba, Winnipeg, MB R3T 2N2 Canada
- Shared Health Manitoba, Winnipeg, MB R3T 2N2 Canada
- Children’s Hospital Winnipeg, 840 Sherbrook St, Winnipeg, MB R3E 0Z3 Canada
| | - Yannick Émond
- Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l’Assomption, Montréal, QC H1T 2M4 Canada
| | - Gerald Evans
- Kingston General Hospital, 76 Stuart St, Kingston, ON K7L 2V7 Canada
| | - Charles Frenette
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC H4A 3J1 Canada
| | - Susan Fryters
- Alberta Health Services, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9 Canada
| | - Greg German
- Health PEI, 16 Garfield St, Charlottetown, PEI C1A 6A5 Canada
| | - Jennifer M. Grant
- University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4 Canada
| | - Jennifer Happe
- Infection Prevention and Control Canada, Red Deer, AB T4N 6R2 Canada
| | - Kevin Katz
- North York General Hospital, 4001 Leslie St, North York, ON M2K 1E1 Canada
| | - Pamela Kibsey
- Royal Jubilee Hospital, 1952 Bay St, Victoria, BC V8R 1J8 Canada
| | - Justin Kosar
- Saskatchewan Health Authority, Saskatoon, SK S7N 0W8 Canada
| | - Joanne M. Langley
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
- Dalhousie University, 6299 South St, Halifax, NS B3H 4R2 Canada
| | - Bonita E. Lee
- Stollery Children’s Hospital, Edmonton, AB T6G 2B7 Canada
- University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Marie-Astrid Lefebvre
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC H4A 3J1 Canada
| | - Jerome A. Leis
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
| | - Allison McGeer
- Sinai Health System, 600 University Ave, Toronto, ON M5G 1X5 Canada
- University of Toronto, 27 King’s College Cir, Toronto, ON M5S Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7 Canada
| | - Heather L. Neville
- Nova Scotia Health Authority, 1276 South Park St, Halifax, NS B3H 2Y9 Canada
| | - Andrew Simor
- University of Toronto, 27 King’s College Cir, Toronto, ON M5S Canada
- Sunnybrook Health Sciences Centre, 2015 Bayview Ave, Toronto, ON M4N 3M5 Canada
| | - Kathryn Slayter
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
| | - Kathryn N. Suh
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON K1H 8L6 Canada
| | - Alena Tse-Chang
- Stollery Children’s Hospital, Edmonton, AB T6G 2B7 Canada
- University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Karl Weiss
- SMBD-Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1E2 Canada
| | - John Conly
- Alberta Health Services, 1620 29 St NW, Calgary, AB T2N 4L7 Canada
- University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1 Canada
| | - the Canadian Nosocomial Infection Surveillance Program
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
- SickKids, 555 University Ave, Toronto, ON M5G 1X8 Canada
- Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4 Canada
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC H4A 3J1 Canada
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON K1H 8L6 Canada
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
- Dalhousie University, 6299 South St, Halifax, NS B3H 4R2 Canada
- Alberta Health Services, 1620 29 St NW, Calgary, AB T2N 4L7 Canada
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9 Canada
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1 Canada
- University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7 Canada
- University of Manitoba, Winnipeg, MB R3T 2N2 Canada
- Shared Health Manitoba, Winnipeg, MB R3T 2N2 Canada
- Children’s Hospital Winnipeg, 840 Sherbrook St, Winnipeg, MB R3E 0Z3 Canada
- Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l’Assomption, Montréal, QC H1T 2M4 Canada
- Kingston General Hospital, 76 Stuart St, Kingston, ON K7L 2V7 Canada
- Alberta Health Services, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9 Canada
- Health PEI, 16 Garfield St, Charlottetown, PEI C1A 6A5 Canada
- University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4 Canada
- Infection Prevention and Control Canada, Red Deer, AB T4N 6R2 Canada
- North York General Hospital, 4001 Leslie St, North York, ON M2K 1E1 Canada
- Royal Jubilee Hospital, 1952 Bay St, Victoria, BC V8R 1J8 Canada
- Saskatchewan Health Authority, Saskatoon, SK S7N 0W8 Canada
- Stollery Children’s Hospital, Edmonton, AB T6G 2B7 Canada
- University of Alberta, Edmonton, AB T6G 2R7 Canada
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
- Sinai Health System, 600 University Ave, Toronto, ON M5G 1X5 Canada
- University of Toronto, 27 King’s College Cir, Toronto, ON M5S Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7 Canada
- Nova Scotia Health Authority, 1276 South Park St, Halifax, NS B3H 2Y9 Canada
- Sunnybrook Health Sciences Centre, 2015 Bayview Ave, Toronto, ON M4N 3M5 Canada
- SMBD-Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1E2 Canada
- University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1 Canada
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