scholarly journals Prevalence of Antimicrobial Use in a Network of Canadian Hospitals in 2002 and 2009

2015 ◽  
Vol 26 (2) ◽  
pp. 85-89 ◽  
Author(s):  
Geoffrey Taylor ◽  
Denise Gravel ◽  
Lynora Saxinger ◽  
Kathryn Bush ◽  
Kimberley Simmonds ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Organ Transplant ◽  
Surveillance Program ◽  
Antimicrobial Use ◽  
Solid Organ ◽  
Eastern Canada ◽  
Infection Surveillance ◽  
Simultaneous Use

BACKGROUND: Increasing antimicrobial resistance has been identified as an important global health threat. Antimicrobial use is a major driver of resistance, especially in the hospital sector. Understanding the extent and type of antimicrobial use in Canadian hospitals will aid in developing national antimicrobial stewardship priorities.METHODS: In 2002 and 2009, as part of one-day prevalence surveys to quantify hospital-acquired infections in Canadian Nosocomial Infection Surveillance Program hospitals, data were collected on the use of systemic antimicrobial agents in all patients in participating hospitals. Specific agents in use (other than antiviral and antiparasitic agents) on the survey day and patient demographic information were collected.RESULTS: In 2002, 2460 of 6747 patients (36.5%) in 28 hospitals were receiving antimicrobial therapy. In 2009, 3989 of 9953 (40.1%) patients in 44 hospitals were receiving antimicrobial therapy (P<0.001). Significantly increased use was observed in central Canada (37.4% to 40.8%) and western Canada (36.9% to 41.1%) but not in eastern Canada (32.9% to 34.1%). In 2009, antimicrobial use was most common on solid organ transplant units (71.0% of patients), intensive care units (68.3%) and hematology/oncology units (65.9%). Compared with 2002, there was a significant decrease in use of first-and second-generation cephalosporins, and significant increases in use of carbapenems, antifungal agents and vancomycin in 2009. Piperacillin-tazobactam, as a proportion of all penicillins, increased from 20% in 2002 to 42.8% in 2009 (P<0.001). There was a significant increase in simultaneous use of >1 agent, from 12.0% of patients in 2002 to 37.7% in 2009.CONCLUSION: From 2002 to 2009, the prevalence of antimicrobial agent use in Canadian Nosocomial Infection Surveillance Program hospitals significantly increased; additionally, increased use of broad-spectrum agents and a marked increase in simultaneous use of multiple agents were observed.

scholarly journals Variability in Antimicrobial Use Among Hospitals Participating in the Canadian Nosocomial Infection Surveillance Program

2020 ◽  
Vol 41 (S1) ◽  
pp. s509-s509
Author(s):  
Wallis Rudnick ◽  
Linda Pelude ◽  
Michelle Science ◽  
Daniel J.G. Thirion ◽  
Jeannette Comeau ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Anatomical Therapeutic Chemical ◽  
Health Agency ◽  
Antibiotic Use ◽  
Teaching Hospitals ◽  
Surveillance Program ◽  
Antimicrobial Use ◽  
Defined Daily Doses ◽  
Infection Surveillance ◽  
Days Of Therapy

Background: The association between antimicrobial use (AMU) and emergence of antimicrobial resistance is well documented. The Canadian Nosocomial Infection Surveillance Program (CNISP) has conducted sentinel surveillance of AMU at participating Canadian hospitals since 2009 resulting in the largest pan-Canadian hospital database of dispensed antimicrobials. Objectives: Describe interhospital variability of AMU across Canada. Methods: Hospitals submit annual AMU data based on patient days (PD). Antimicrobials were measured in defined daily doses (DDD) for adults using the WHO Anatomical Therapeutic Chemical (ATC) system. The AMU data among pediatric patients have been available since 2017 using days of therapy (DOT). Surveillance includes systemic antibacterial agents (J01 ATC codes), oral metronidazole, and oral vancomycin. AMU was assessed using quintiles, interquartile ranges (IQR), and relative IQRs (upper- and lower-quartile values divided by the median). Results: Between 2009 and 2018, 20–26 hospitals participated in adult surveillance each year (35 teaching hospitals and 3 nonteaching hospitals participated in ≥1 year). Over this period, overall AMU decreased by 13% at participating adult hospitals from 645 to 560 DDD per 1,000 PD. AMU varied substantially between hospitals, but this variability decreased over time (Fig. 1). In 2009, the IQRs for overall AMU spanned 309 DDD per 1,000 PD, and in 2018 it spanned only 103 DDD per 1,000 PD. This decrease in variability was due to large decreases in use among hospitals with high use in 2009–2010. Among hospitals in the highest use quintile in 2009–2010, AMU decreased, on average, 44 DDD per 1,000 PD each year. Among hospitals in the lowest use quintile in 2009–2010, AMU increased, on average, 6 DDD per 1,000 PD each year. In 2018, antibiotics with the largest absolute IQR variability were cefazolin (61–113 DDD per 1,000 PD), piperacillin-tazobactam (32–64 DDD per 1,000 PD), and vancomycin (24–49 DDD per 1,000 PD). Among antibiotics with ≥1 DDD per 1,000 PD, antibiotics with the largest relative IQR variability were tobramycin (0.3–6 DDD per 1,000 PD), cefadroxil (0.08–9 DDD per 1,000 PD), and linezolid (0.2–3 DDD per 1,000 PD). In 2018, the IQR for overall pediatric AMU (n = 7 teaching hospitals) was 426–581 DOT per 1,000 PD. Antibiotics with the largest IQRs were vancomycin (0.6–58 DOT per 1,000 PD), cefazolin (33–88 DOT per 1,000 PD), and tobramycin (3–57 DOT per 1,000 PD). Among antibiotics with ≥1 DOT per 1,000 PD in 2018, antibiotics with the largest relative IQRs were tobramycin (3–57 DOT per 1,000 PD), cefuroxime (1–6 DOT per 1,000 PD), and amoxicillin (8–42 DOT per 1,000 PD). Conclusions: There is wide variation in overall antibiotic use across hospitals. Variation between AMU at adult hospitals has decreased between 2009 and 2018; in 2018, antibiotics with the largest IQRs were cefazolin and piperacillin-tazobactam. Benchmarking AMU is crucial for informing antimicrobial stewardship efforts.Funding: CNISP is funded by the Public Health Agency of Canada.Disclosures: Allison McGeer reports funds to her institution from Pfizer and Merck for projects for which she is the principal investigator. She also reports consulting fees from Sanofi-Pasteur, Sunovion, GSK, Pfizer, and Cidara.

scholarly journals N-CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N-CDAD Prevalence Surveillance Project

2001 ◽  
Vol 12 (2) ◽  
pp. 81-88 ◽  
Author(s):  
Meaghen Hyland ◽  
Marianna Ofner-Agostini ◽  
Mark Miller ◽  
Shirley Paton ◽  
Marie Gourdeau ◽  
...  
Keyword(s):  
Health Care ◽  
Nosocomial Infection ◽  
Toxin Production ◽  
Health Care Facilities ◽  
Surveillance Program ◽  
Prevention Measures ◽  
Case Definitions ◽  
Infection Surveillance ◽  
Positive Stool ◽  
The Impact

BACKGROUND:A 1996 preproject survey among Canadian Hospital Epidemiology Committee (CHEC) sites revealed variations in the prevention, detection, management and surveillance ofClostridium difficile-associated diarrhea (CDAD). Facilities wanted to establish national rates of nosocomially acquired CDAD (N-CDAD) to understand the impact of control or prevention measures, and the burden of N-CDAD on health care resources. The CHEC, in collaboration with the Laboratory Centre for Disease Control (Health Canada) and under the Canadian Nosocomial Infection Surveillance Program, undertook a prevalence surveillance project among selected hospitals throughout Canada.OBJECTIVE:To establish national prevalence rates of N-CDAD.METHODS:For six weeks in 1997, selected CHEC sites tested all diarrheal stools from inpatients for eitherC difficiletoxin orC difficilebacteria with evidence of toxin production. Questionnaires were completed for patients with positive stool assays who met the case definitions.RESULTS:Nineteen health care facilities in eight provinces participated in the project. The overall prevalence of N-CDAD was 13.0% (95% CI 9.5% to 16.5%). The mean number of N-CDAD cases were 66.3 cases/100,000 patient days (95% CI

Predicting Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infection Incidence Rates using Canadian Nosocomial Infection Surveillance Program (CNISP)

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Jona Gjevori ◽  
Kahina Abdesselam
Keyword(s):  
Public Health ◽  
Staphylococcus Aureus ◽  
Nosocomial Infection ◽  
Bloodstream Infection ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Incidence Rates ◽  
Surveillance Program ◽  
Methicillin Resistant ◽  
Infection Surveillance ◽  
Healthcare Associated

Methicillin-Resistant Staphylococcus aureus (MRSA) is among the most prevalent nosocomial pathogens globally, causing significant morbidity, mortality, and healthcare costs. MRSA bloodstream infection (BSI) incidence rates in Canadian hospitals have significantly risen by almost 60% and have a mortality of over 20% upon Intensive Care Unit admission. MRSA is believed to be spread through healthcare workers; thus, high hand hygiene compliancy in addition to environmental cleaning are the cornerstone countermeasures to disrupting its transmission. The Public Health Agency of Canada (PHAC), in collaboration with the Canadian Nosocomial Infection Surveillance Program (CNISP), conducts national, sentinel surveillance on healthcare-associated infections like MRSA. As a Student Epidemiologist, I developed a research proposal detailing two study objectives: 1) develop a regression model to predict all incident MRSA BSI rates among acute-care hospitals in Canada using CNISP MRSA BSI incident cases from 2000 to 2019, and 2) create a compartmental (Susceptible-Infected-Recovered-Deceased) model to determine the impact of various Infection Prevention and Control (IPC) measures on the risk of healthcare-associated MRSA BSI transmission specifically. This study hopes to demonstrate that proper IPC compliance is associated with lower incident MRSA BSI rates with the goal being to produce a manuscript draft by 2021. MRSA poses a serious threat to patient safety globally and is becoming a growing national public health concern in Canada; determining which IPC strategy is most effective at disrupting MRSA transmission is essential to reducing incidence and mortality rates.

Polymicrobial bloodstream infections (PBI): An under-realized complication in patients with cancer (2005–2006)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19590-19590
Author(s):  
A. Safdar ◽  
G. H. Rodriguez ◽  
D. S. Raval ◽  
G. P. Bodey ◽  
K. V. Rolston
Keyword(s):  
Cancer Patients ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Hematologic Malignancy ◽  
Bacterial Load ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Response To Treatment ◽  
Apache Ii Score ◽  
Solid Organ

19590 Background: Little attention has been directed to PBI in cancer patients. Methods: Fifty-four PBI episodes were evaluated retrospectively in 51 patients after obtaining IRB approval. PBI was defined as ≥ 2 organisms isolated from a single blood culture or sample(s) obtained within 72 hrs after the initial positive culture. All values are given as median ± s.d. Results: The age was 57 ± 16 years. Thirty-four patients had hematologic malignancy of whom, 73% had acute leukemia. Nearly half (47%) of the patients had refractory or relapsed cancer. Thirty-two (63%) were neutropenic (ANC 0 ± 144 cells/UL) and 31 patients (61%) had lymphocytopenia (ALC 0 ± 86 cells/UL). At the time of infection diagnosis, APACHE II score was 16 ± 5 and 5 (10%) patients were receiving systemic corticosteroids (> 600 mg prednisone equivalent dose). Thirty-one PBI episodes (57%) occurred while patients were receiving systemic antimicrobial agents for prophylaxis or treatment. In 83% of PBI episodes, positive specimens were collected from central venous catheter (CVC). Catheter-related infection necessitating CVC removal occurred in nearly half of these cases (24/45). Twenty-two (41%) PBI episodes were associated with high bacterial load (> 100 CFU/ml). The overall response to treatment was 86%. In 39 of 42 episodes (77%) treated with concordant antimicrobial therapy infection resolved. Whereas, in only 5 episodes (9%) treated with discordant antimicrobial therapy, infection resolution occurred (P = 0.07). There were no differences in PBI outcomes in patients with hematologic malignancies vs. solid-organ cancers, patients > 50 years vs. < 50 years of age or among neutropenic patients who had recovery of neutropenia during infection episode vs. patients in whom neutropenia persisted. Conclusions: The overall high response of concordant antimicrobial therapy for even high-risk cancer patients with PBI looks encouraging. No significant financial relationships to disclose. [Table: see text]

Nosocomial Infection Surveillance in the United States: Historical Perspective

1987 ◽  
Vol 8 (11) ◽  
pp. 450-453 ◽  
Author(s):  
James M. Hughes
Keyword(s):  
United States ◽  
Nosocomial Infection ◽  
Infection Control ◽  
Nosocomial Infections ◽  
Control Program ◽  
The United States ◽  
National Database ◽  
Surveillance Program ◽  
Infection Control Program ◽  
Infection Surveillance

AbstractDuring the past 30 years, many important strides have been made in the prevention of nosocomial infections in the United States. Infection control programs have been established in hospitals throughout the country. Techniques for surveillance of nosocomial infections have been developed and utilized extensively. Results of the Study on the Efficacy of Nosocomial Infection Control (SENIC Project) and the experience with surveillance of surgical wound infections have documented the fact that surveillance is an integral component of an effective nosocomial infection control program. In recent years, a number of approaches to nosocomial infection surveillance have been proposed as alternatives to comprehensive or hospital-wide surveillance. In 1986, four surveillance components were introduced in the National Nosocomial Infections Surveillance (NNIS) system to provide participating institutions the option to tailor their surveillance program to their local needs and priorities while continuing to provide information to the national database on nosocomial infections. Infection control practitioners currently face a challenge to develop more meaningful nosocomial infection rates to permit identification of new infection control priorities for their institution and to assess progress toward specific prevention objectives.

Antimicrobial Use Prior to the Acquisition of Multiresistant Bacteria

2002 ◽  
Vol 23 (3) ◽  
pp. 155-158 ◽  
Author(s):  
Matthieu Eveillard ◽  
Jean-Luc Schmit ◽  
François Eb
Keyword(s):  
Staphylococcus Aureus ◽  
Prospective Study ◽  
Clavulanic Acid ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Antimicrobial Use ◽  
Third Generation ◽  
Multiresistant Bacteria ◽  
Amoxicillin Clavulanic Acid ◽  
Third Generation Cephalosporins

AbstractWe assessed whether patients who acquired methicillin-resistantStaphylococcus aureus(MRSA) had less exposure to antimicrobial agents than did those who acquired Enterobacteriaceae that produced extended-spectrum β-lactamase (ESβL). In a 6-month, prospective study, ESβL carriers had received antimicrobial therapy more often than had MRSA carriers. Amoxicillin-clavulanic acid, fluoroquinolones, and third-generation cephalosporins, especially ceftazidime, had been prescribed more often for ESβL carriers than for MRSA carriers.

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