The evolving epidemiology of <i>Clostridium difficile</i> infection in Canadian hospitals during a postepidemic period (2009–2015)

Katz, Kevin; Golding, George R.; Choi, Kelly Baekyung; Pelude, Linda; Amaratunga, Kanchana; Taljaard, Monica; Alexandre, Stéphanie; Collet, Jun Chen; Davis, Ian; Du, Tim; Evans, Gerald A.; Frenette, Charles; Gravel, Denise; Hota, Susy; Kibsey, Pamela; Langley, Joanne M.; Lee, Bonita E.; Lemieux, Camille; Longtin, Yves; Mertz, Dominik; Mieusement, Lorraine Maze Dit; Minion, Jessica; Moore, Dorothy; Mulvey, Michael R.; Richardson, Susan; Simor, Andrew E.; Stagg, Paula; Suh, Kathryn N.; Taylor, Geoffrey; Wong, Alice; Thampi, Nisha

doi:10.1503/cmaj.180013

Cited by 55 publications

(54 citation statements)

References 20 publications

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“…In addition, prevalence of health care-associated infections among patients in the ICU markedly declined. These results are consistent with other CNISP data, 11,20 which suggests improvements in the prevention of health care-associated infections in Canadian acute care hospitals. This trend has occurred despite some changes in hospital patient populations that would be expected to increase infection risk, such as a higher proportion of patients in the ICU.…”

Section: Discussionsupporting

confidence: 92%

“…(CNISP) provides data on the incidence of selected health careassociated infections and antimicrobial resistant organisms [11][12][13][14][15] and conducted point-prevalence surveys in 2002 and 2009. 16,17 In 2017, we replicated a point-prevalence survey in CNISP hospitals, to provide an up-to-date estimate of the burden of health careassociated infections and antimicrobial-resistant organisms causing these infections in Canadian hospitals, and to describe the trends observed over time in the 3 surveys.…”

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confidence: 99%

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Trends in health care–associated infections in acute care hospitals in Canada: an analysis of repeated point-prevalence surveys

Mitchell

Taylor

Rudnick

et al. 2019

CMAJ

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H ealth care-associated infections represent substantial burden on health care systems in highly developed countries, including Canada. 1-3 In 2002, health careassociated infection developed in an estimated 5% of patients admitted to hospital in the United States, resulting in 1.7 million infections and 98 000 deaths. 1 A study using 2015 data from the European Antimicrobial Resistance Surveillance Network (EARS-Net) from 30 countries estimated 426 277 infections with antibioticresistant bacteria were associated with health care, with an attributable mortality of 33 110. 2 A point-prevalence study conducted in 2015 estimated that there were 687 200 health careassociated infections in US hospitals. 3 Timely data on the occurrence of health care-associated infections and antimicrobial resistant organisms in Canadian hospitals are essential to the response to an evolving epidemiologic situation. Internationally, prevalence surveys are widely used to estimate the incidence and burden of disease from these infections. 3-10 The Canadian Nosocomial Infection Surveillance Program RESEARCH HEALTH SERVICES

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

Trends in health care–associated infections in acute care hospitals in Canada: an analysis of repeated point-prevalence surveys

Mitchell

Taylor

Rudnick

et al. 2019

CMAJ

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“…Further study is needed to fully understand the effects of reductions in fluoroquinolone use in CNISP hospitals where there has been a concurrent reduction in the rates of hospital-associated MRSA and CDI. Notably, over the surveillance period, there was a reduction in CDI caused by strain type NAP1 (associated with ribotype 027 and highly fluoroquinolone resistant) at CNISP hospitals [22]. Reductions in CDI infections have been associated with decreased fluoroquinolone use in Canada [21], the United Kingdom [23], and the United States [24,25].…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016

Rudnick

Science

Thirion

et al. 2020

Antimicrob Resist Infect Control

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Background: Antimicrobial resistance is a growing threat to the world's ability to prevent and treat infections. Links between quantitative antibiotic use and the emergence of bacterial resistance are well documented. This study presents benchmark antimicrobial use (AMU) rates for inpatient adult populations in acute-care hospitals across Canada. Methods: In this retrospective surveillance study, acute-care adult hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) submitted annual AMU data on all systemic antimicrobials from 2009 to 2016. Information specific to intensive care units (ICUs) and non-ICU wards were available for 2014-2016. Data were analyzed using defined daily doses (DDD) per 1000 patient days (DDD/1000pd). Results: Between 2009 and 2016, 16-18 CNISP adult hospitals participated each year and provided their AMU data (22 hospitals participated in ≥1 year of surveillance; 11 in all years). From 2009 to 2016, there was a significant reduction in use (12%) (from 654 to 573 DDD/1000pd, p = 0.03). Fluoroquinolones accounted for the majority of this decrease (47% reduction in combined oral and intravenous use, from 129 to 68 DDD/1000pd, p < 0.002). The top five antimicrobials used in 2016 were cefazolin (78 DDD/1000pd), piperacillin-tazobactam (53 DDD/1000pd), ceftriaxone (49 DDD/1000pd), vancomycin (combined oral and intravenous use was 44 DDD/1000pd; 7% of vancomycin use was oral), and ciprofloxacin (combined oral and intravenous use: 42 DDD/1000pd). Among the top 10 antimicrobials used in 2016, ciprofloxacin and metronidazole use decreased significantly between 2009 and 2016 by 46% (p = 0.002) and 26% (p = 0.002) respectively. Ceftriaxone (85% increase, p = 0.0008) and oral amoxicillin-clavulanate (140% increase, p < 0.0001) use increased significantly but contributed only a small component (8.6 and 5.0%, respectively) of overall use.

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“…Ribotyping surveillance data has shown that the molecular epidemiology of the disease is shifting. The prevalence of the epidemic ribotype 027 is decreasing globally, while ribotypes 106 and 017 have become the most common strains in Europe and Asia, respectively [10][11][12][13][14][15]. The most recent national data provided by the Centers for Disease and Control (CDC) shows similar trends in the US, however, this data is derived from 1000 to 1500 annual samples submitted from ten states, not including Texas [13].…”

Section: Introductionmentioning

confidence: 99%

PCR ribotypes of Clostridioides difficile across Texas from 2011 to 2018 including emergence of ribotype 255

Gonzales-Luna

Carlson

Dotson

et al. 2020

Emerging Microbes & Infections

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Clostridioides difficile infection (CDI) is the most prevalent healthcare-associated infection in the United States and carries a significant healthcare system burden. As part of an ongoing, active surveillance system of C. difficile throughout Texas, the objective of this study was to assess changes in C. difficile ribotypes of clinical isolates obtained from hospitalized patients in Texas over the past seven years. Fifty hospitals located in Texas, USA sent C. difficile positive stool specimens to a centralized laboratory for PCR ribotyping and toxin characterization between 2011 and 2018. Data collected included specimen collection date, patient age, and sex. Strain genotypes were compiled, and changes in ribotype distribution over time were assessed. Overall, 7796 samples were ribotyped from predominately female patients (58.4%) aged 62 ± 19 years. Samples were obtained from all geographic regions of Texas including Houston/Southwest region (n = 5129; 85%), Dallas/North Texas (n = 579, 9.6%), Central Texas (n = 164; 2.7%), and South Texas (n = 162; 2.6%). The 10 most common ribotypes comprised 73% of all isolates tested during the study period. The most common ribotypes were 027 (17.5%), followed by 014-020 (16.1%), 106 (11.6%), and 002 (9.1%). The prevalence of ribotypes 027, 001, and 078-126 declined significantly over time, while ribotypes 106 and 054 increased in prevalence (P < 0.001). Furthermore, the emergence of a novel ribotype 255 strain was observed. Differences in ribotype distribution were also noted based on age and geographic distribution (P < 0.001, each). This seven-year study demonstrated changing molecular epidemiology of C. difficile in Texas, including the emergence of a novel ribotype 255.

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The evolving epidemiology of Clostridium difficile infection in Canadian hospitals during a postepidemic period (2009–2015)

Cited by 55 publications

References 20 publications

Trends in health care–associated infections in acute care hospitals in Canada: an analysis of repeated point-prevalence surveys

Trends in health care–associated infections in acute care hospitals in Canada: an analysis of repeated point-prevalence surveys

Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016

PCR ribotypes of Clostridioides difficile across Texas from 2011 to 2018 including emergence of ribotype 255

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