Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2017–2021

Abstract

Background Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) continue to contribute to excess morbidity and mortality among Canadians. This report describes epidemiologic and laboratory characteristics and trends of HAIs and AMR from 2017 to 2021 ( Candida auris 2012–2021) using surveillance and laboratory data submitted by hospitals to the Canadian Nosocomial Infection Surveillance Program (CNISP) and by provincial laboratories to the National Microbiology Laboratory (NML). Methods Data collected from 88 Canadian sentinel acute care hospitals between January 1, 2017, and December 31, 2021, for Clostridioides difficile infections (CDI), carbapenemase-producing Enterobacterales (CPE), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) and vancomycin-resistant Enterococcus (VRE) BSIs. Candida auris ( C. auris ) surveillance was initiated in 2019 by CNISP and in 2012 by the NML. Case counts, rates, outcomes, molecular characterization and antimicrobial resistance profiles are presented. Results From 2017 to 2021, increased rates per 10,000 patient days were observed for MRSA BSIs (35%; 0.84–1.13), VRE BSIs (43%; 0.23–0.33) and CPE infections (166%, 0.03–0.08). CDI rates decreased 11% (5.68–5.05). Thirty-one C. auris isolates were identified in Canada from 2012 to 2021, with the majority from Western Canada (68%). Conclusion From 2017 to 2021, the incidence of MRSA and VRE BSIs, and CPE infections increased in Canadian acute care hospitals participating in a national sentinel network (CNISP) while CDI decreased. Few C. auris isolates were identified from 2012 to 2021. Reporting standardized surveillance data and the consistent application of infection prevention and control practises in acute care hospitals are critical to help decrease the burden of HAIs and AMR in Canada.

Plasmid genomic epidemiology of bla KPC carbapenemase-producing Enterobacterales in Canada, 2010–2021

“…bla KPC was the dominant type of carbapenemase isolated from 2010 to 2014 by the Canadian Nosocomial Infection Surveillance Program (CNISP), where they comprised 50%–83% of all carbapenemases analyzed per year ( 6 ). From 2017 to 2021, the rates of carbapenemase-producing Enterobacterales infections in Canada increased by 166% (from n = 20 in 2017 to n = 55 in 2021), and bla KPC remains the most common carbapenemase type detected in Canada ( 7 ).…”