Antibiotic resistance research and surveillance
Antibiotic use and antibiotic resistance are monitored in Canada. Attention is especially given to antibiotic resistance in healthcare settings and in our food chain.
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Antibiotic use and resistance surveillance systems
Antibiotic use and antibiotic resistance are monitored in Canada through four surveillance systems:
- Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS)
- Canadian Nosocomial Infection Surveillance Program (CNISP)
- Enhanced surveillance of antimicrobial-resistant gonorrhea program (ESAG)
- Canadian Tuberculosis Laboratory Surveillance System
The National Microbiology Laboratory of the Public Health Agency of Canada (the Agency) contributes to research and surveillance by:
- providing services to provincial public health and hospital laboratories that help confirm antibiotic resistance in bacteria,
- supporting outbreak investigations, and
- conducting research to identify new technologies and methodologies that could influence both antibiotic use and the identification of resistant bacteria.
The Laboratory for Foodborne Zoonoses looks at the public health risks of antibiotic resistance that come from interactions between humans, animals and the environment.
Canadian Integrated Program for Antimicrobial Resistance Surveillance
CIPARS monitors trends in antimicrobial use and antimicrobial resistance. It examines the relationship between antimicrobials used in animals and humans and the potential effects on public health. The program also monitors select bacteria from samples taken from farms, meat processing plants, retail food outlets and from humans.
CIPARS gathers information to support the following activities:
- creation of evidence-based policies to support responsible antimicrobial use in hospital, community and agricultural settings, and
- identification of potential measures that could minimize the emergence and spread of resistant bacteria among animals, food and people.
Canadian Nosocomial Infection Surveillance Program
The Agency collects national data on antimicrobial-resistant organisms through CNISP. This program provides rates and trends of healthcare-associated infections in Canadian healthcare facilities. This allows for the comparison of rates nationally and internationally.
CNISP currently collects data from 60 participating hospitals in 10 provinces.
Enhanced surveillance of antimicrobial-resistant gonorrhea program
The Agency is establishing a new enhanced surveillance system for antimicrobial-resistant gonorrhea (ESAG). The ESAG program provides:
- information on risk factors associated with antimicrobial-resistant gonorrhea,
- surveillance evidence to inform treatment recommendations in the Canadian Guidelines on Sexually Transmitted Infections, and
- evidence for public health interventions to minimize the spread of antimicrobial-resistant gonorrhea in Canada.
Human antibiotic use in Canada
In Canada, nearly 23 million antibiotic prescriptions were written in 2013. The majority were for the following health concerns:
- 45% for respiratory conditions
- 15.7% for upper-respiratory tract infections
- 13.9% for urinary tract infections
- 10.4% for ear infections
In many instances these types of infections are caused by viruses rather than bacteria. Antibiotics are not effective in treating viruses.
Antibiotic resistance in healthcare settings
Antibiotic-resistant bacteria can spread in healthcare settings. If these resistant bacteria spread, they are tracked. This allows for comparisons over time and between regions.
Here are some examples of the types of bacteria and the kind of information that is tracked:
Methicillin-resistant Staphylococcus aureus (MRSA):
- Nationally, MRSA infection rates have been declining since 2009.
- Adult infection rates have steadily declined since 2009 while pediatric (ages 0 to 18 years) infection rates have increased.
- Skin, soft tissue or burns are the most common source of MRSA clinical infections.
Vancomycin-resistant enterococci (VRE):
- VRE infection rates remain low but have been increasing since 2008.
- 52% of VRE infections are among patients aged 65 years or older.
- 51% of all VRE infections are urinary tract infections.
Carbapenem-resistant Enterobacteriaceae (CRE):
- The number of cases of CRE remains low in Canada.
- Rates of CRE in hospitals have remained stable between 2010 and 2012.
Antibiotic resistance and the food chain
Antibiotic resistance can spread through the food chain making it important to examine the relationship between the antibiotics used in animals and in people. It is also important to examine that relationship for its impacts on human antibiotic resistance.
- Important antibiotics used to treat human infections are also used to prevent and treat illness in animals.
- Antibiotics are used in veterinary medicine and in animals used for food production.
- Resistant bacteria can also spread to farm workers who directly handle farm animals.
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