Via CIDRAP, Chris Dall writes: Canada reports rising MRSA, VRE but drop in antibiotic use. Excerpt:
A new report from the Canadian Antimicrobial Resistance Surveillance System (CARSS) shows rising antibiotic resistance in two major healthcare-associated pathogens, along with noteworthy decreases in antibiotic use in humans and animals.
The CARRS-2017 Report is the third published by the Public Health Agency of Canada (PHAC) and includes surveillance data on antimicrobial resistance and use, both in humans and animals, through 2016. The report is based on available surveillance data from the PHAC's nine surveillance systems and laboratory reference services. This year's report includes new data on antibiotic-resistant infections and antibiotic use in community settings.
The two pathogens of concern are methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The CARRS report shows that the overall rate of MRSA infection in sentinel hospitals in Canada increased from 2.84 cases to 3.13 cases per 10,000 patient-days from 2011 through 2016, with a decrease in healthcare-associated MRSA (HA-MRSA) cases (from 1.93 cases in 2011 to 1.69 in 2016) and an increase in community-associated cases (from 0.56 cases to 0.96 cases per 1,000 admissions).
Most concerning was a fivefold increase in HA-MRSA bloodstream infections (BSIs) in the country's pediatric hospitals—from 0.08 to 0.43 cases per 10,000 patient-days between 2011 and 2016.
The rate of VRE infections in Canada, meanwhile, rose from 0.41 cases per 10,000 patient-days in 2015 to 0.44 cases in 2016. While that's a reduction from a high of 0.61 cases in 2012, it still represents a significant rise since 2007, when the rate was 0.10 cases per 10,000 patient-days.
In addition, the report shows that the rate of VRE BSI in sentinel adult hospitals more than doubled from 2011 to 2016, climbing from 0.12 cases per 10,000 patient-days to 0.26 cases. "This finding points to the need for ongoing monitoring of this microorganism in Canada," the authors of the report write.
The report also found that drug-resistant gonorrhea is becoming an increasing problem in Canada, matching a trend that has been observed worldwide. From 2014 through 2015, the proportion of cultured Neisseria gonorrhea isolates that were resistant to at least one antibiotic rose from 52% to 60%, with increases observed in the proportion of isolates resistant to azithromycin (from 1.3% in 2010 to 4.7% in 2015) and in the proportion of isolates with decreased susceptibility to the cephalosporin antibiotics cefixime or ceftriaxone (from 1.1% and 2.7% in 2014, respectively, to 1.9% and 3.5% in 2015).
Since 2001, the rate of gonorrhea infections in Canada has more than doubled. But the country has not yet reported any treatment failures resulting from resistance to azithromycin and decreased susceptibility to cephalosporins—the currently recommended dual therapy for gonorrhea.
On a positive note, the CARSS-2017 Report showed that the rate of healthcare-associated Clostridium difficile infection (CDI) in Canada continued to decline, falling from 6.64 cases per 10,000 patient-days in 2015 to 4.05 cases in 2016. Surveillance of sentinel hospitals beginning in 2015 showed that 37% of all CDI reported in patients admitted to those hospitals was community-associated.