Prevalence of Antimicrobial-Resistant Pathogens in Canadian Hospitals: Results of the Canadian Ward Surveillance Study (CANWARD 2008)

ABSTRACT A total of 5,282 bacterial isolates obtained between 1 January and 31 December 31 2008, inclusive, from patients in 10 hospitals across Canada as part of the Canadian Ward Surveillance Study (CANWARD 2008) underwent susceptibility testing. The 10 most common organisms, representing 78.8% of all clinical specimens, were as follows: Escherichia coli (21.4%), methicillin-susceptible Staphylococcus aureus (MSSA; 13.9%), Streptococcus pneumoniae (10.3%), Pseudomonas aeruginosa (7.1%), Klebsiella pneumoniae (6.0%), coagulase-negative staphylococci/Staphylococcus epidermidis (5.4%), methicillin-resistant S. aureus (MRSA; 5.1%), Haemophilus influenzae (4.1%), Enterococcus spp. (3.3%), Enterobacter cloacae (2.2%). MRSA comprised 27.0% (272/1,007) of all S. aureus isolates (genotypically, 68.8% of MRSA were health care associated [HA-MRSA] and 27.6% were community associated [CA-MRSA]). Extended-spectrum β-lactamase (ESBL)-producing E. coli occurred in 4.9% of E. coli isolates. The CTX-M type was the predominant ESBL, with CTX-M-15 the most prevalent genotype. MRSA demonstrated no resistance to ceftobiprole, daptomycin, linezolid, telavancin, tigecycline, or vancomycin (0.4% intermediate intermediate resistance). E. coli demonstrated no resistance to ertapenem, meropenem, or tigecycline. Resistance rates with P. aeruginosa were as follows: colistin (polymyxin E), 0.8%; amikacin, 3.5%; cefepime, 7.2%; gentamicin, 12.3%; fluoroquinolones, 19.0 to 24.1%; meropenem, 5.6%; piperacillin-tazobactam, 8.0%. A multidrug-resistant (MDR) phenotype occurred frequently in P. aeruginosa (5.9%) but uncommonly in E. coli (1.2%) and K. pneumoniae (0.9%). In conclusion, E. coli, S. aureus (MSSA and MRSA), P. aeruginosa, S. pneumoniae, K. pneumoniae, H. influenzae, and Enterococcus spp. are the most common isolates recovered from clinical specimens in Canadian hospitals. The prevalence of MRSA was 27.0% (of which genotypically 27.6% were CA-MRSA), while ESBL-producing E. coli occurred in 4.9% of isolates. An MDR phenotype was common in P. aeruginosa.

[1]  M. Kollef,et al.  Surveillance for Vancomycin-Resistant Enterococci: Type, Rates, Costs, and Implications , 2006, Infection Control & Hospital Epidemiology.

[2]  Ronald N. Jones,et al.  Antimicrobial resistance and molecular epidemiology of vancomycin-resistant enterococci from North America and Europe: a report from the SENTRY antimicrobial surveillance program. , 2007, Diagnostic microbiology and infectious disease.

[3]  Michael R. Mulvey,et al.  Prevalence of Antimicrobial-Resistant Pathogens in Canadian Hospitals: Results of the Canadian Ward Surveillance Study (CANWARD 2007) , 2009 .

[4]  M. Mulvey,et al.  Comparison of community-associated and health care-associated methicillin-resistant Staphylococcus aureus in Canada: results from CANWARD 2007. , 2009 .

[5]  J. Burke,et al.  Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[6]  J. Lynch,et al.  Streptococcus pneumoniae: Does Antimicrobial Resistance Matter? , 2009, Seminars in respiratory and critical care medicine.

[7]  H. Chambers,et al.  Community-associated MRSA--resistance and virulence converge. , 2005, The New England journal of medicine.

[8]  J. Quinn,et al.  Antimicrobial Resistance among Gram-Negative Bacilli Causing Infections in Intensive Care Unit Patients in the United States between 1993 and 2004 , 2007, Journal of Clinical Microbiology.

[9]  M. Mulvey,et al.  Comparative Genomics of Canadian Epidemic Lineages of Methicillin-Resistant Staphylococcus aureus , 2007, Journal of Clinical Microbiology.

[10]  J. Burke,et al.  Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship , 2007 .

[11]  V. Tam,et al.  Surveillance and Correlation of Antibiotic Prescription and Resistance of Gram-Negative Bacteria in Singaporean Hospitals , 2010, Antimicrobial Agents and Chemotherapy.

[12]  M. Battegay,et al.  Secular Trend and Risk Factors for Antimicrobial Resistance in Escherichia coli Isolates in Switzerland 1997–2007 , 2009, Infection.

[13]  G. Horsman,et al.  Community-associated Methicillin-resistant Staphylococcus aureus, Canada , 2005, Emerging infectious diseases.

[14]  D. Church,et al.  Molecular Epidemiology of CTX-M-Producing Escherichia coli in the Calgary Health Region: Emergence of CTX-M-15-Producing Isolates , 2007, Antimicrobial Agents and Chemotherapy.

[15]  Richard Platt,et al.  Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[16]  M. Cetron,et al.  Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. , 2000, The New England journal of medicine.

[17]  I. R. Reid.  Calcium supplements and nail quality. , 2000, The New England journal of medicine.

[18]  R. Gaynes,et al.  Antimicrobial resistance prevalence rates in hospital antibiograms reflect prevalence rates among pathogens associated with hospital-acquired infections. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[19]  D. Fisman,et al.  Selective digestive tract decontamination: A tough pill to swallow. , 2009, The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale.

[20]  Mary Jane Ferraro,et al.  Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically : approved standard , 2000 .

[21]  B. Wickes,et al.  First Report of the Emergence of CTX-M-Type Extended-Spectrum β-Lactamases (ESBLs) as the Predominant ESBL Isolated in a U.S. Health Care System , 2008, Antimicrobial Agents and Chemotherapy.

[22]  M. Mulvey,et al.  A preliminary guideline for the assignment of methicillin-resistant Staphylococcus aureus to a Canadian pulsed-field gel electrophoresis epidemic type using spa typing. , 2008, The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale.

[23]  G. Peirano,et al.  High Prevalence of ST131 Isolates Producing CTX-M-15 and CTX-M-14 among Extended-Spectrum-β-Lactamase-Producing Escherichia coli Isolates from Canada , 2010, Antimicrobial Agents and Chemotherapy.

[24]  Ronald N. Jones,et al.  Summary trends for the Meropenem Yearly Susceptibility Test Information Collection Program: a 10-year experience in the United States (1999-2008). , 2009, Diagnostic microbiology and infectious disease.

[25]  D. Oliveira,et al.  Multiplex PCR Strategy for Rapid Identification of Structural Types and Variants of the mec Element in Methicillin-Resistant Staphylococcus aureus , 2002, Antimicrobial Agents and Chemotherapy.

[26]  Ronald N. Jones,et al.  Characterization of Vancomycin-Heteroresistant Staphylococcus aureus from the Metropolitan Area of Detroit, Michigan, over a 22-Year Period (1986 to 2007) , 2008, Journal of Clinical Microbiology.

[27]  Ronald N. Jones,et al.  Characterization of Vancomycin-Heteroresistant Staphylococcus aureus from the Metropolitan Area of Detroit, Michigan, over a 22-Year Period (1986 to 2007) , 2008, Journal of Clinical Microbiology.

[28]  M. Mulvey,et al.  Comparison of Antimicrobial Resistance Profiles among Extended-Spectrum-β-Lactamase-Producing and Acquired AmpC β-Lactamase-Producing Escherichia coli Isolates from Canadian Intensive Care Units , 2008, Antimicrobial Agents and Chemotherapy.

[29]  M. Mulvey,et al.  Ambler Class A Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella spp. in Canadian Hospitals , 2004, Antimicrobial Agents and Chemotherapy.

[30]  Ronald N. Jones,et al.  Rapid emergence of blaCTX-M among Enterobacteriaceae in U.S. Medical Centers: molecular evaluation from the MYSTIC Program (2007). , 2008, Microbial drug resistance.

[31]  M. Mulvey,et al.  Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration , 2006, Canadian Medical Association Journal.

[32]  D. Hoban,et al.  Antibiotic activity against urinary tract infection (UTI) isolates of vancomycin-resistant enterococci (VRE): results from the 2002 North American Vancomycin Resistant Enterococci Susceptibility Study (NAVRESS). , 2003, The Journal of antimicrobial chemotherapy.

[33]  D. Meltzer,et al.  Prevalence of antimicrobial-resistant bacteria isolated from older versus younger hospitalized adults: results of a two-centre study. , 2009, The Journal of antimicrobial chemotherapy.

[34]  M. Mulvey,et al.  Prevalence and characterization of extended-spectrum beta-lactamase-producing Enterobacteriaceae isolated in Canadian hospitals: Results from CANWARD 2007 , 2009 .

[35]  M. Loeb,et al.  Detection and Characterization of Heterogeneous Vancomycin-Intermediate Staphylococcus aureus Isolates in Canada: Results from the Canadian Nosocomial Infection Surveillance Program, 1995-2006 , 2009, Antimicrobial Agents and Chemotherapy.

[36]  M. Mulvey,et al.  Characterization of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and extended-spectrum beta-lactamase-producing Escherichia coli in intensive care units in Canada: Results of the Canadian National Intensive Care Unit (CAN-ICU) study (2005-2006). , 2008, The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale.

[37]  R. Weinstein,et al.  Community-associated Methicillin-resistant Staphylococcus aureus , 2006, Emerging infectious diseases.

[38]  R. Holman,et al.  Infectious disease hospitalizations in the United States. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[39]  Michael R. Mulvey,et al.  Antimicrobial-Resistant Pathogens in Intensive Care Units in Canada: Results of the Canadian National Intensive Care Unit (CAN-ICU) Study, 2005-2006 , 2008, Antimicrobial Agents and Chemotherapy.

[40]  A. Kelly,et al.  Significant reductions in methicillin‐resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture‐change program and subsequent successful statewide roll‐out , 2008, The Medical journal of Australia.

[41]  J. Zacherl,et al.  Is your food free of wood? , 2000, The New England journal of medicine.

[42]  D H Persing,et al.  Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing , 1995, Journal of clinical microbiology.

[43]  K. Laupland,et al.  Molecular Characteristics of Extended-Spectrum-β-Lactamase-Producing Escherichia coli Isolates Causing Bacteremia in the Calgary Health Region from 2000 to 2007: Emergence of Clone ST131 as a Cause of Community-Acquired Infections , 2009, Antimicrobial Agents and Chemotherapy.