Carbapenem-resistant Gram-negative bacilli in Canada 2009-10: results from the Canadian Nosocomial Infection Surveillance Program (CNISP)

OBJECTIVES

To investigate the occurrence and molecular mechanisms associated with carbapenemases in carbapenem-resistant Gram-negative isolates from Canadian cases.

METHODS

Twenty hospital sites across Canada submitted isolates for a 1 year period starting 1 September 2009. All Enterobacteriaceae with MICs ≥ 2 mg/L and Acinetobacter baumannii and Pseudomonas aeruginosa with MICs ≥ 16 mg/L of carbapenems were submitted to the National Microbiology Laboratory (NML) where carbapenem MICs were confirmed by Etest and isolates were characterized by PCR for carbapenemase genes, antimicrobial susceptibilities, PFGE and plasmid isolation.

RESULTS

A total of 444 isolates (298 P. aeruginosa, 134 Enterobacteriaceae and 12 A. baumannii) were submitted to the NML of which 274 (61.7%; 206 P. aeruginosa, 59 Enterobacteriaceae and 9 A. baumannii) met the inclusion criteria as determined by Etest. Carbapenemase genes were identified in 30 isolates: bla(GES-5) (n = 3; P. aeruginosa), bla(KPC-3) (n = 7; Enterobacteriaceae), bla(NDM-1) (n = 2; Enterobacteriaceae), bla(VIM-2) and bla(VIM-4) (n = 8; P. aeruginosa) bla(SME-2) (n = 1; Enterobacteriaceae) and bla(OXA-23) (n = m9; A. baumannii). PFGE identified a cluster in each of Enterobacteriaceae, P. aeruginosa and A. baumannii corresponding to isolates harbouring carbapenemase genes. Three KPC plasmid patterns (IncN and FllA) were identified where indistinguishable plasmid patterns were identified in unrelated clinical isolates.

CONCLUSIONS

Carbapenemases were rare at the time of this study. Dissemination of carbapenemases was due to both dominant clones and common plasmid backbones.

Geographical and temporal aspects of an outbreak of off-flavours in bulk-tank milk in Prince Edward Island, Canada

The geographical and temporal dynamics of the outbreak of off-flavours in bulk-tank milk that occurred between September 2000 and June 2002 in Prince Edward Island (PEI) dairy herds were described using spatial, temporal and space-time scan statistics. Results suggested clustering both in time and space. We found one primary cluster (six case herds, feed off-flavour, October 2000 to January 2001) and two secondary clusters formed of feed (5 case herds, October 2000 to January 2001)) and rancid (five case herds, December 2000 to March 2001) off-flavours, respectively. The relative risk (RR) for producing off-flavoured milk was similar for these three clusters (RR=6.4).

Risk factors for milk off-flavours in dairy herds from Prince Edward Island, Canada

A sudden increase in the incidence of milk off-flavours in bulk tank milk from Prince Edward Island (Canada) dairy farms in the late 1990s prompted an investigation of potential herd-level risk factors. A prospective case-control study was conducted from 2000 to 2002. Data on herd management were obtained by questionnaire and field investigation from all the 62 identified off-flavour positive farms (cases) and 62 loosely matched (for data-collection convenience) off-flavour negative farms (controls). Forty-three of the 62 cases (69%) of milk off-flavours identified during the study period were classified as "transmitted" (feed) off-flavours, and 9 (15%), 6 (10%), and 4 (6%) as "rancid", "oxidized" and "malty" off-flavours, respectively. Given this evidence and the relatively low incidence of other flavour defects in milk, only transmitted-flavour cases were considered in the analyses of risk factors. Poor air quality in the lactating cows' barn (OR = 40.8), using baled silage as the main forage (OR = 10.6), as well as feeding roughage before milking (OR = 253.3) or as a free choice (OR = 3.2) all were significantly (P < 0.05) associated with the incidence of transmitted flavours in bulk-tank milk. Clipping the hair on the cows' udder (OR = 0.07) and changing the bedding material more than once a day (OR = 0.12) were protective. The finding about feeding baled silage before milking has raised hypotheses about silage composition (in particular the off-flavour compounds or their precursors) and also about the process of silage making itself.