When the colistin-resistant gene, mcr-1, was first found in China in 2015, health officials around the world knew that the gene would inevitably appear in their countries. It has since been detected in other parts of Asia, Europe, and North America, including Canada, which just released a 2016 report from their Canadian Antimicrobial Resistance Surveillance System.
When the colistin-resistant gene, mcr-1, was first found in China in 2015, health officials around the world knew the gene would inevitably appear in their countries. It has since been detected in other parts of Asia, Europe, and North America, including Canada, which just released a 2016 report from their Canadian Antimicrobial Resistance Surveillance System (CARSS).
This new report is the second annual compilation of data from nine Public Health Agency of Canada (PHAC) surveillance systems and laboratory services, tasked with tracking and providing information for their Federal Action Plan on the state of antimicrobial resistance (AMR) and antimicrobial use (AMU) in the country. With antibiotic-resistant bacteria plaguing healthcare systems around the world, the report aims to support decision making by Canada’s health professionals and policy makers. “This year’s report demonstrates the Government of Canada’s continued commitment to leading activities to prevent, limit and control the emergence and spread of AMR as described in Antimicrobial Resistance and Use in Canada: A Federal Framework for Action,” states the report.
The World Health Organization says that antimicrobial resistance is a global problem threatening the effectiveness of current treatment and the prevention of dangerous illnesses such as tuberculosis. Hard-to-treat infections caused by bacteria such as Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae drive up medical costs and can lead to lengthy hospital stays. With over-prescription of antibiotic medications contributing to the growing problem of “superbugs,” the Canadian report states that the country’s volume of those prescriptions has remained relatively stable over the last 13 years. In 2014, Canadians dispensed 23 million prescriptions of antibiotics, putting the country 12th in a list of 31 countries for antibiotic use. The annual overall expenditure on antimicrobials in Canada is $786 million, with community dispensing accounting for 87% and hospital purchases accounting for 13% of this amount.
The good news out of this year’s report is that for select antimicrobial-resistant bacteria, the recent surveillance shows generally stable rates of resistance and, in some cases, a decline in infection rates for certain bacteria. Canada’s rates of hospitalization for methicillin-resistant Staphylococcus aureus, a common cause of healthcare-associated infections, have dropped by 25% since 2008, with rates of vancomycin-resistant Enterococci infections down, too. Likewise, with Clostridium difficile infections remaining an issue for hospitals and other health facilities, rates in Canada declined in 2014 from 5.2 cases per 1,000 patient admissions to 3.4 cases per 1,000 patient admissions, after a decade of increasing rates. While those infection rates still remain higher than 2007 levels, the new numbers indicate that Canada is stemming the problem of at least some drug-resistant bacteria.
On the other hand, infection rates for some priority bacterial organisms in Canada continue to rise. Cases of sexually transmitted gonorrhea infections, caused by the Neisseria gonorrhoeae bacteria, had a sharp 43% rise from 2004 to 2013 with a marked rate of antibiotic resistance. Of the isolates collected and tested, 18.2% were resistant to penicillin, 47.3% were resistant to tetracycline, 32.0% were resistant to erythromycin, and 34.0% were resistant to ciprofloxacin. The rate of infection for group A Streptococcus rose from 2009 to 2013, from 4.0 to 4.7 cases per 100,000 people, with most of those infections occurring in infants under one year of age and in adults 60 years of age or older. The strains present in Canada continue to respond to first-line antibiotic treatment with stable or declining resistance to second-line medications.
The Canadian report notes gaps from lack of data on antimicrobial resistant bacteria in smaller hospitals, rural and northern healthcare facilities, and First Nations and Inuit communities. “PHAC has made significant progress strengthening its surveillance systems in order to provide a comprehensive and integrated public health picture of AMR and AMU in Canada,” says the report. “Ongoing surveillance gaps present a challenge to developing a comprehensive picture in both the community and hospital settings. PHAC is committed to working with provincial and territorial governments, and other partners to address surveillance gaps. The identification of the increasing resistance of microorganisms to antimicrobials, and questions regarding the appropriate use of antimicrobials, demonstrate the necessity for continued vigilance in order to address the issue of AMR and AMU in Canada.”