Antimicrobial Resistance in Canada

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Antimicrobial Resistance in Canada

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Antibiotic resistance

• Hospital
• methicillin-resistant Staphylococcus aureus
  (MRSA)
• vancomycin-resistant enterococci (VRE)
• multi-resistant Gram negatives
• Community
• penicillin-resistant Streptococcus pneumoniae
• MRSA

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Streptococcus pneumoniae

• Is the leading cause of infectious morbidity and
  mortality worldwide
• Is the most common bacterial cause of middle ear
  infections, meningitis, sinusitis and pneumonia
  in the community
• Each year in Canada it accounts for 5,000 cases
  of bloodstream infections, 700,000 cases of
  middle ear infection, and 12,500 cases of
  pneumonia causing hospitalization

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The Emergence of Penicillin Non-Susceptible
Pneumococci in the U.S.
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Penicillin resistant S. pneumoniae Canadian
isolates 1988, 1993-2001
Canadian Bacterial Surveillance Network, Jan. 2002
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Worldwide Distribution of Penicillin Resistant
Pneumococci
Russia7
Canada 14
Israel54
Japan64
USA41
Hong Kong80
Mexico 53
Saudi Arabia 62
Kenya 49
Singapore53
Brazil 31
South Africa 80
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Erythromycin-resistant S. pneumoniae Canadian
isolates 1988, 1993-2001
Canadian Bacterial Surveillance Network, Jan. 2002

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Worldwide S. pneumoniae Macrolide Resistance in
1999
Canada 11
Russia7
Europe20
Israel23
Japan78
USA33
Hong Kong82
Mexico 22
Saudi Arabia 18
Kenya 0.5
Singapore55
Brazil 4.0
South Africa 13
Resistance defined as erythromycin MIC ³1mg/L
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Penicillin resistant S. pneumoniaeOntario
isolates 1988, 1993-2001
Canadian Bacterial Surveillance Network, Jan. 2002
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Erythromycin resistant S. pneumoniae Ontario
isolates 1988, 1993-2001
Canadian Bacterial Surveillance Network, Jan. 2002

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Canadian Bacterial Surveillance Network

• Clinical laboratories (65) serving Canadian
  hospitals and communities voluntarily submit
  bacterial isolates to CBSN
• Testing is performed at Mount Sinai Hospital
  Laboratory
• Data is entered into a central database, some
  elements of which are currently available on-line
  at http//microbiology.mtsinai.on.ca

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Penicillin Resistance Rates and
PrescriptionsCanadian Bacterial Surveillance
Network (1988-2001)
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Levofloxacin Resistance in S. pneumoniaeResults
from a Cross-Canada Surveillance Study
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Staphylococcus aureus

• Is the most common cause of hospital-acquired
  infections (pneumonia, wounds and bloodstream
  infections)
• More than 95 of patients with S. aureus
  infections worldwide do not respond to first-line
  antibiotics
• Since the 1980s MRSA has been increasing and is
  now entrenched in many hospitals
• Vancomycin is the only drug that can consistently
  treat MRSA and resistance is emerging to it
• MRSA is now spreading into the community

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Methicillin-Resistant Staphylococcus aureus
(MRSA)in Canada (1995-99)
Canadian Nosocomial Infection Surveillance
Program
Simor, Ofner-Agnostini, Byrce and the MRSA
Working Group, CNISP, 40th ICAAC, Sept 17-20,
2000
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Number of Colonized / Infected Patients with MRSA
(Ontario)
.
LPTP Survey, 1996/97/98/99/00,01
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Number of VRE Cases Reported in Ontario
Laboratories

LPTP Survey, 1996/97/98/99/00,01