Estimated Reduction in the Burden of Nontyphoidal Salmonella Illness in Canada Circa 2019.

Nontyphoidal Salmonella (NTS) is a leading cause of acute gastrointestinal illness in Canada, and reported cases have been on the rise since the early 2000s. To address this trend, agri-food industry partners and government have worked to identify and implement interventions, guided by the enhanced information provided by whole-genome sequencing, to reduce the incidence of NTS. A substantial reduction in the number of NTS cases reported occurred in 2019. Due to underreporting and underdiagnosis factors, the observed decrease in the number of reported cases represents a fraction of the true number of illnesses averted in the community. The objective of this study was to: (1) use burden of illness estimation methodologies to estimate the true number of NTS illnesses, hospitalizations, and deaths prevented, and (2) estimate the economic savings associated with the prevention of these cases. Compared with the previous 5 years, there were an estimated 25,821 fewer illnesses, 213 fewer hospitalizations, and 2 fewer deaths attributable to NTS in 2019. This corresponds to an estimated reduction of 26.9 million Canadian dollars in the economic burden of NTS. Although causality cannot be proven by this study, the findings are suggestive that the strategically implemented suite of public health actions, including genomic-based surveillance, policy changes, and interventions by the government and industry, were successful in reducing the economic and health burden of NTS infections in Canada.

Country food consumption in Yukon, Northwest Territories and Nunavut, Foodbook study 2014-2015.

BACKGROUND: This article presents a descriptive summary of the consumption of various country food (i.e. locally harvested plant and animal foods) products by residents of Yukon (YT), Northwest Territories (NT) and Nunavut (NU). Data were collected as part of the Foodbook study in 2014-2015. METHODS: The Foodbook study was conducted by telephone over a one-year period. Respondents were asked about consumption of a wide range of food products over the previous seven days. Residents of the territories were also asked about consumption of regionally-specific country food. Data were weighted to develop territorial estimates of consumption. Data on age, gender, location, income and education were also collected. RESULTS: The national response rate for the Foodbook survey was 19.9%. In total, 1,235 residents of the territories participated in the study (YT, n=402; NT, n=458; NU, n=375). Consumption of any country food during the previous seven days was reported by 77.5%, 60.7%, and 66.4% of participants in NU, NT and YT, respectively. CONCLUSION: Responses to country food questions asked alongside the main Foodbook questionnaire provide insight on country food consumption in YT, NT and NU.

Discharge Destination from a Rehabilitation Unit After Acute Ischemic Stroke.

BACKGROUND: We reviewed numerous variables for ischemic stroke patients admitted to a rehabilitation unit to determine those that were statistically associated with discharge destination. METHODS: A retrospective chart review of patients with ischemic stroke discharged from the rehabilitation unit between January 1, 2005 and December 31, 2015. Variables were examined for their association with discharge destination (home versus long-term care (LTC)). Univariable relationships with discharge destination were assessed, and a multivariable logistic regression model was built. RESULTS: Univariate predictors of discharge to LTC: advanced age, decreasing admission and discharge functional independence measure (FIM) scores, increasing change in FIM score from admission to discharge, dependency, residence outside of home before the stroke, absence of a caregiver, urinary and bowel incontinence, low Berg balance score at admission and discharge, low Montreal Cognitive Assessment scores, smoking, chronic heart failure, and an inability to transfer. Multivariable logistic regression: five factors remained significant predictors with LTC disposition: advanced age, bowel incontinence, residence outside of the home prior to stroke, right hemisphere site of the stroke, and absence of a caregiver. CONCLUSIONS: Several easily measured variables were significantly associated with discharge to LTC versus home following stroke rehabilitation.

Canadian Consumer Food Safety Practices and Knowledge: Foodbook Study.

Understanding consumers' food safety practices and knowledge supports food safety education for the prevention of foodborne illness. The objective of this study was to describe Canadian consumer food safety practices and knowledge. This study identifies demographic groups for targeted food safety education messaging and establishes a baseline measurement to assess the effectiveness of food safety interventions over time. Questions regarding consumer food safety practices and knowledge were included in a population-based telephone survey, Foodbook, conducted from November 2014 to March 2015. The results were analyzed nationally by age group and by gender. The results showed that approximately 90% of Canadians reported taking the recommended cleaning and separating precautions when handling raw meat to prevent foodborne illness. Only 29% of respondents reported using a food thermometer when cooking any meat, and even fewer (12%) reported using a food thermometer for small cuts of meat such as chicken pieces. The majority (>80%) of Canadians were aware of the foodborne illness risks related to chicken and hamburger, but fewer (<40%) were aware of the risks related to frozen chicken nuggets, alfalfa sprouts, soft unpasteurized cheese, and unpasteurized juices. Generally, men were less likely to follow cooking instructions on packaging and took fewer steps to prevent cross-contamination than women. The youngest (18 to 29 years) age group was less likely to take steps to avoid cross-contamination and was less aware of the risks associated with eating an undercooked hamburger. The oldest (60+ years) respondents were less likely to be aware of the risks associated with raw eggs, alfalfa sprouts, and unpasteurized juice than the middle (30 to 59 years) age group. As a priority, food safety education in Canada should focus on increasing people's awareness of high-risk foods, specifically foods for which the awareness of risk found in this study was low; targeting messaging to demographic groups as appropriate; and promoting the use of food thermometers when cooking meat and poultry.

Antibiotic prescriptions for outpatient acute rhinosinusitis in Canada, 2007-2013.

INTRODUCTION: Acute rhinosinusitis (ARS) is a respiratory disease commonly caused by viral infections. Physicians regularly prescribe antibiotics despite bacterial etiologies being uncommon. This is of concern, as this use adds to the selection pressure for resistance. Here we present the descriptive epidemiology of acute rhinosinusitis and corresponding antibiotic prescribing practices by Canadian outpatient physicians from 2007-2013. MATERIALS/METHODS: Diagnosis and antibiotic prescription data for ARS were extracted from the Canadian Disease and Therapeutic Index for 2007 to 2013, and population data were acquired from Statistics Canada. ARS diagnosis and antibiotic prescription rates and frequencies of antibiotic classes were calculated. RESULTS: Eighty-eight percent of patients diagnosed with ARS in 2013 were adults, with a greater rate of antibiotic prescriptions observed among the adults relative to the pediatric patients (1632.9 and 468.6 antibiotic prescriptions per 10,000 inhabitants). Between 2007 and 2013, the ARS diagnosis rate decreased from 596 to 464 diagnoses per 10,000 inhabitants, while the percentage of diagnoses with antibiotic prescriptions at the national level remained stable (87% to 84%). From 2007 to 2013, prescription rates for macrolides decreased from 203.5 to 105.4 prescriptions per 10,000 inhabitants. In 2013, penicillins with extended spectrum were more commonly prescribed compared to macrolides among adult patients (153.5 and 105.4 prescriptions per 10,000 inhabitants, respectively). CONCLUSION: This study is the first to describe physician antibiotic prescribing practices for treatment of ARS in Canada. Results show that antibiotic treatment for ARS represents an area for implementing antimicrobial stewardship, and through it, managing antibiotic resistance. Further work is required to better understand diagnosing practices and treatment criteria for ARS, and use this information to further assist physicians to limit unnecessary antibiotic prescribing practices.

Surveillance of antimicrobial resistance in clinical isolates of Pasteurella multocida and Streptococcus suis from Ontario swine.

Susceptibility results for Pasteurella multocida and Streptococcus suis isolated from swine clinical samples were obtained from January 1998 to October 2010 from the Animal Health Laboratory at the University of Guelph, Guelph, Ontario, and used to describe variation in antimicrobial resistance (AMR) to 4 drugs of importance in the Ontario swine industry: ampicillin, tetracycline, tiamulin, and trimethoprim-sulfamethoxazole. Four temporal data-analysis options were used: visualization of trends in 12-month rolling averages, logistic-regression modeling, temporal-scan statistics, and a scan with the "What's strange about recent events?" (WSARE) algorithm. The AMR trends varied among the antimicrobial drugs for a single pathogen and between pathogens for a single antimicrobial, suggesting that pathogen-specific AMR surveillance may be preferable to indicator data. The 4 methods provided complementary and, at times, redundant results. The most appropriate combination of analysis methods for surveillance using these data included temporal-scan statistics with a visualization method (rolling-average or predicted-probability plots following logistic-regression models). The WSARE algorithm provided interesting results for quality control and has the potential to detect new resistance patterns; however, missing data created problems for displaying the results in a way that would be meaningful to all surveillance stakeholders.

Les résultats de sensibilité pour des isolats de Pasteurella multocida et Streptococcus suis provenant d'échantillons cliniques de porcs furent obtenus du Animal Health Laboratory de l'Université de Guelph pour la période de janvier 1998 à octobre 2010, et utilisés pour décrire la variation dans la résistance antimicrobienne (AMR) à quatre antibiotiques d'importance dans l'industrie porcine en Ontario : l'ampicilline, la tétracycline, la tiamuline, et le trimethoprime-sulfaméthoxazole. Quatre options temporelles d'analyse des données ont été utilisées : visualisation des tendances des moyennes mobiles de 12 mois, modélisation de régression logistique, statistiques d'un scan temporel, et un scan avec l'algorithme «Qu'y a-t-il d'étrange avec des évènements récents?¼ (WSARE). Les tendances d'AMR variaient entre les antibiotiques pour un agent pathogène et entre les agents pathogènes pour un antibiotique unique, ce qui suggère que la surveillance AMR pour un agent pathogène spécifique serait préférable à des données indicatrices. Les quatre méthodes ont fourni des données complémentaires, et parfois des résultats redondants. La combinaison la plus appropriée de méthodes d'analyse pour la surveillance en utilisant ces données incluait les statistiques d'un scan temporel avec une méthode de visualisation (moyenne mobile ou graphes de probabilité prédite suite à des modèles de régression logistique). L'algorithme WSARE a fourni des résultats intéressants pour le contrôle de qualité et a le potentiel de détecter des nouveaux patrons de résistance; toutefois, des données manquantes ont causé des problèmes pour montrer les résultats d'une manière qui serait signifiante pour toutes les personnes concernées par la surveillance.(Traduit par Docteur Serge Messier).

Does variation among provincial drug formulary antimicrobial listings in Canada influence prescribing rates?

BACKGROUND: The financial accessibility of antimicrobial drugs to the outpatient community in Canada is governed at the provincial level through formularies. Each province may choose to list particular drugs or impose restriction criteria on products in order to guide prescribing and/or curtail costs. Although changes to formularies have been shown to change patterns in the use of individual products and alter costs, no comparison has been made among the provincial antimicrobial formularies with regards to flexibility/stringency, or an assessment of how these formularies impact overall antimicrobial use in the provinces. OBJECTIVES: To summarize provincial antimicrobial formularies and assess whether their relative flexibility/stringency had a statistical impact upon provincial prescription volume during a one year period. METHODS: Provincial drug plan formularies were accessed and summarized for all prescribed antimicrobials in Canada during 2010. The number of general and restricted benefits for each plan was compiled by antimicrobial classification. Population-adjusted prescription rates for all individual antimicrobials and by antimicrobial class were obtained from the Canadian Integrated Program for Antimicrobial Resistance Surveillance. Correlations between the number of general benefits, restricted benefits, and total benefits with the prescription rate in the provinces were assessed by Spearman rank correlation coefficients. RESULTS: Formularies varied considerably among the Canadian provinces. Quebec had the most flexible formulary, offering the greatest number of general benefits and fewest restrictions. In contrast, Saskatchewan's formulary displayed the lowest number of general benefits and most restrictions. Correlation analyses detected a single significant result; macrolide prescription rates decreased as the number of general macrolide benefits increased. All other rates of provincial antimicrobial prescribing and measures of flexibility/stringency revealed no significant correlations. CONCLUSIONS: Although antimicrobial formulary listings are used to guide prescribing rates within a province, our analysis of one year's data of the impact of the antimicrobial formulary structure did not correlate with antimicrobial prescribing rates, and other factors are likely to be at play.

Variation in outpatient oral antimicrobial use patterns among Canadian provinces, 2000 to 2010.

BACKGROUND: The volume and patterns of antimicrobial drug use are key variables to consider when developing guidelines for prescribing, and programs to address stewardship and combat the increasing prevalence of antimicrobial resistant pathogens. Because drug programs are regulated at the provincial level, there is an expectation that antibiotic use may vary among provinces. OBJECTIVE: To assess these potential differences according to province and time. METHODS: Provincial antimicrobial prescribing data at the individual drug level were acquired from the Canadian Integrated Program for Antimicrobial Resistance Surveillance for 2000 to 2010. Data were used to calculate two yearly metrics: prescriptions per 1000 inhabitant-days and the average defined daily doses per prescription. The proportion of liquid oral prescriptions of total prescriptions was also calculated as a proxy measure for the proportion of prescriptions given to children versus adults. To assess the significance of provincial antimicrobial use, linear mixed models were developed for each metric, accounting for repeated measurements over time. RESULTS: Significant differences among provinces were found, as well as significant changes in use over time. Newfoundland and Labrador was found to have significantly higher prescribing rates than all other provinces (P<0.001) in 2010, as well as the mean of all other provinces (P<0.001). In contrast, Quebec exhibited significantly lower prescribing than all other provinces (P<0.001 for all provinces except British Columbia, where P=0.024) and the mean of all other provinces (P<0.001). DISCUSSION/CONCLUSION: Reports of reductions in antimicrobial use at the Canadian level are promising, especially prescribing to children; however, care must be taken to avoid the pitfall of the ecological fallacy. Reductions are not consistent among the provinces or among the classes of antimicrobial drugs dispensed in Canada.

HISTORIQUE: Le volume et les modes d'utilisation d'antimicrobiens sont des variables importantes à envisager lorsqu'on élabore des lignes directrices de prescription et des programmes pour aborder la question de la gouvernance et pour lutter contre la prévalence croissante des pathogènes résistants aux antimicrobiens. Puisque les programmes de médicaments sont réglementés sur la scène provinciale, on s'attend que l'utilisation d'antibiotiques varie entre les provinces. OBJECTIF: Évaluer ces différences potentielles selon la province et dans le temps. MÉTHODOLOGIE: Les chercheurs ont extrait les données sur la prescription de chaque médicament antimicrobien sur la scène provinciale du Programme intégré canadien de surveillance de la résistance aux antimicrobiens entre 2000 et 2010. À l'aide de ces données, ils ont calculé deux mesures annuelles : les prescriptions par 1 000 habitants-jours et les doses thérapeutiques quotidiennes moyennes dispensées par prescription. Ils ont également calculé la proportion de prescriptions orales liquides par rapport aux prescriptions totales pour établir approximativement la proportion de prescriptions administrées aux enfants par rapport aux adultes. Pour évaluer l'importance de l'utilisation d'antimicrobiens sur la scène provinciale, les chercheurs ont élaboré des modèles linéaires mixtes pour chaque mesure, tenant compte de mesures répétées dans le temps. RÉSULTATS: Les chercheurs ont constaté des différences significatives entre les provinces, ainsi que des changements importants d'utilisation dans le temps. Ils ont déterminé que Terre-Neuve-et-Labrador présentait des taux de prescription considérablement plus élevés que toutes les autres provinces (P<0,001) en 2010, ainsi que de la moyenne de toutes les autres provinces (P<0,001). Par contre, le Québec présentait des taux de prescription considérablement plus faibles que toutes les autres provinces (P<0,001 pour toutes les provinces sauf la Colombie-Britannique, où P=0,024) ainsi que de la moyenne de toutes les autres provinces (P<0,001). EXPOSÉ ET CONCLUSION: Les rapports sur la diminution de l'utilisation d'antimicrobiens sur la scène canadienne sont prometteurs, notamment les prescriptions aux enfants. Cependant, il faut s'assurer d'éviter l'écueil des erreurs écologiques. Les réductions ne sont pas uniformes entre les provinces ou entre les classes d'antimicrobiens administrées au Canada.

Longitudinal surveillance of outpatient quinolone antimicrobial use in Canada.

INTRODUCTION: Because antimicrobial use is commonly associated with the development of antimicrobial resistance, monitoring the volume and patterns of use of these agents is important. OBJECTIVE: To assess the use of quinolone antimicrobials within Canadian provinces over time. METHODS: ANTIMICROBIAL PRESCRIBING DATA COLLECTED BY IMS HEALTH CANADA WERE ACQUIRED FROM THE CANADIAN INTEGRATED PROGRAM FOR ANTIMICROBIAL RESISTANCE SURVEILLANCE AND THE CANADIAN COMMITTEE FOR ANTIMICROBIAL RESISTANCE, AND WERE USED TO CALCULATE TWO YEARLY METRICS: prescriptions per 1000 inhabitant-days and the mean defined daily doses (DDDs) per prescription. These measures were used to produce linear mixed models to assess differences among provinces and over time, while accounting for repeated measurements. RESULTS: The quinolone class of antimicrobials is used similarly among Canadian provinces. Year-to-year increases in quinolone prescribing occurred from 1995 to 2010, with a levelling off in the latter years. Year-to-year decreases in the DDDs per prescription were found to be significant from 2000 to 2010. DISCUSSION: Although the overall use of antimicrobials differs significantly among Canadian provinces, the use of the quinolone class does not vary at the provincial level. Results suggest that prescribing of ciprofloxacin may be a potential target for antimicrobial stewardship programs; however, decreases in the average DDDs per prescription suggest continued uptake of appropriate treatment guidelines.

INTRODUCTION: Puisque l'utilisation d'antimicrobiens s'associe souvent à l'apparition d'une résistance antimicrobienne, il est important d'en surveiller le volume et le mode d'utilisation. OBJECTIF: Évaluer l'utilisation d'antimicrobiens de la classe des quinolones au sein des provinces canadiennes au fil du temps. MÉTHODOLOGIE: Les chercheurs ont acquis les données de prescription d'antimicrobiens colligées par IMS Health Canada auprès du Programme intégré canadien de surveillance de la résistance aux antimicrobiens et du Comité canadien sur la résistance aux antibiotiques et les ont utilisées pour calculer deux mesures annuelles : les prescriptions par 1 000 habitants-jours et les doses quotidiennes définies (DTD) moyennes par prescription. Ils les ont utilisées pour produire des modèles linéaires mixtes afin d'évaluer les différences entre les provinces et au fil du temps, tout en tenant compte des mesures répétées. RÉSULTATS: Les antimicrobiens de la classe des quinolones sont utilisés de manière similaire dans les provinces canadiennes. Les prescriptions annuelles de quinolone ont augmenté de 1995 à 2010, mais ont plafonné au cours des dernières années. Les DTD par prescription ont diminué annuellement de manière significative entre 2000 et 2010. EXPOSÉ: Même si l'utilisation globale d'antimicrobiens diffère de manière significative entre les provinces canadiennes, l'utilisation de la classe des quinolones ne varie pas sur la scène provinciale. D'après les résultats, la prescription de ciprofloxacine peut être une cible potentielle des programmes de gestion des antimicrobiens. Cependant, les diminutions des DTD moyennes par prescription sont indicatrices d'une assimilation continue des directives thérapeutiques pertinentes.

Provincial and temporal variation in macrolide and lincosamide antimicrobial use by outpatients in Canada, 1995 to 2010.

INTRODUCTION: Because antimicrobial use is commonly associated with the development of antimicrobial resistance, monitoring the volume and patterns of use of these agents is very important. OBJECTIVE: To assess the use of macrolide and lincosamide (ML) antimicrobials within Canadian provinces over time, and to compare use rates with those reported by European countries. METHODS: ANTIMICROBIAL PRESCRIBING DATA WERE USED TO DEVELOP TWO YEARLY METRICS: prescriptions per 1000 inhabitant-days (PrIDs) and the mean defined daily doses (DDDs) per prescription, which were then used to build linear mixed models to assess differences among provinces over time. RESULTS: After accounting for repeated measures over time, prescribing rates (PrIDs) varied significantly according to province and year (P<0.001). However, little change occurred within each province over the time frame studied; from 1995 to 2010, each province had a PrID change <0.01. Quebec and British Columbia had significantly lower prescribing rates than all other provinces. No overall secular trend was apparent. In contrast, the DDDs per prescription did not vary significantly according to province, but showed a significant year-to-year increase. DISCUSSION: ML prescribing varied among provinces in Canada between 1995 and 2010, but remained relatively stable within each province. The average DDDs per ML prescription did not vary according to province, but increased linearly over time. These increases are likely to indicate that fewer prescriptions are being written for children over time, a practice supported by good antimicrobial stewardship principles.

INTRODUCTION: Puisque l'utilisation d'antimicrobiens s'associe souvent à l'apparition d'une résistance aux antimicrobiens, il est très important d'en surveiller le volume et les profils d'utilisation. OBJECTIF: Évaluer l'utilisation des antimicrobiens marcolides et lincasomides (ML) dans les provinces canadiennes au fil du temps et comparer les taux d'utilisation par rapport à ceux des pays européens. MÉTHODOLOGIE: Les données de prescription d'antimicrobiens ont permis d'établir deux mesures annuelles : les prescriptions par 1 000 habitants-jours (PrID) et les doses quotidiennes définies (DQD) moyennes par prescription, qui ont ensuite été utilisées pour créer des modèles linéaires mixtes d'évaluation des différences entre les provinces au fil du temps. RÉSULTATS: Après avoir tenu compte des mesures répétées au fil du temps, les taux de prescription (PrID) variaient de manière significative selon la province et l'année (P<0,001). Cependant, on a observé peu de changements dans chaque province pendant la période de l'étude. En effet, de 1995 à 2010, chaque province présentait un changement des PrID de moins de 0,01. Le Québec et la Colombie-Britannique présentaient un taux de prescription considérablement plus faible que toutes les autres provinces. Aucune tendance lourde globale n'était apparente. Par contre, les DQD par prescription ne variaient pas de manière significative selon la province, mais augmentait de manière significative d'une année à l'autre. EXPOSÉ: Les prescriptions de ML étaient variables entre les provinces du Canada de 1995 à 2010, mais demeuraient relativement stables dans chaque province. Les DQD moyennes par prescription de ML ne variaient pas selon la province, mais présentaient une augmentation linéaire au fil du temps. Ces augmentations sont susceptibles d'indiquer que moins de prescriptions sont rédigées pour les enfants au fil du temps, une pratique soutenue par de bons principes de gouvernance antimicrobienne.

Longitudinal surveillance of outpatient ß-lactam antimicrobial use in Canada, 1995 to 2010.

INTRODUCTION: ß-lactam antimicrobials are the most commonly prescribed group of antimicrobials in Canada, and are categorized by the WHO as critically and highly important antimicrobials for human medicine. Because antimicrobial use is commonly associated with the development of antimicrobial resistance, monitoring the volume and patterns of use of these agents is highly important. OBJECTIVE: To assess the use of penicillin and cephalosporin antimicrobials within Canadian provinces over the 1995 to 2010 time frame according to two metrics: prescriptions per 1000 inhabitant-days and the average defined daily doses dispensed per prescription. METHODS: Antimicrobial prescribing data were acquired from the Canadian Integrated Program for Antimicrobial Resistance Surveillance and the Canadian Committee for Antimicrobial Resistance, and population data were obtained from Statistics Canada. The two measures developed were used to produce linear mixed models to assess differences among provinces and over time for the broad-spectrum penicillin and cephalosporin groups, while accounting for repeated measurements at the provincial level. RESULTS: Significant differences among provinces were found, as well as significant changes in use over time. A >28% reduction in broad-spectrum penicillin prescribing occurred in each province from 1995 to 2010, and a >18% reduction in cephalosporin prescribing occurred in all provinces from 1995 to 2010, with the exception of Manitoba, where cephalosporin prescribing increased by 18%. DISCUSSION: Significant reductions in the use of these important drugs were observed across Canada from 1995 to 2010. Newfoundland and Labrador and Quebec emerged as divergent from the remaining provinces, with high and low use, respectively.

INTRODUCTION: Les ß-lactamines représentent le groupe d'antimicrobiens le plus prescrit au Canada et, d'après l'OMS, elles revêtent une importance capitale en médecine humaine. Puisque l'utilisation d'antimicrobiens s'associe souvent au développement d'une résistance antimicrobienne, il est essentiel de surveiller le volume et les modes d'utilisation de ces agents. OBJECTIF: Évaluer l'utilisation de pénicilline et de céphalosporines au sein des provinces canadiennes entre 1995 et 2010 selon deux mesures : les prescriptions par 1 000 habitants-jours et les doses théra-peutiques quotidiennes moyennes dispensées par prescription. MÉTHODOLOGIE: Les chercheurs ont extrait les données sur la prescription d'antimicrobiens du Programme intégré canadien de surveillance de la résistance aux antimicrobiens et du Comité canadien sur la résistance aux antibiotiques, et les données en population de Statistique Canada. À l'aide des deux mesures élaborées, ils ont produit des modèles linéaires mixtes pour évaluer les différences entre les provinces et dans le temps dans les groupes de pénicilline à large spectre et de céphalosporines, tout en tenant compte des mesures répétées sur la scène provinciale. RÉSULTATS: Les chercheurs ont constaté des différences significatives entre les provinces, ainsi que des changements importants d'utilisation dans le temps. Les prescriptions de pénicilline à large spectre ont diminué de plus de 28 % dans chaque province entre 1995 et 2010, et celles de céphalosporines ont reculé de plus de 18 % dans toutes les provinces entre 1995 et 2010, à l'exception du Manitoba, où les prescriptions de céphalosporines ont augmenté de 18 %. EXPOSÉ: Les chercheurs ont observé d'importantes réductions dans l'utilisation de ces médicaments au Canada entre 1995 et 2010. Terre-Neuve-et-Labrador et le Québec divergeaient des autres provinces, avec un usage élevé et faible, respectivement.

Longitudinal surveillance of outpatient tetracycline, sulfonamide-trimethoprim and 'other' antimicrobial use in Canada, 1995 to 2010.

INTRODUCTION: Monitoring the volume and patterns of use of antimicrobial agents is important in light of antimicrobial resistance. OBJECTIVE: To assess the use of three antimicrobial groups - tetracycline, sulfonamide-trimethoprim and 'other' antimicrobials - within Canadian provinces over time. METHODS: Prescription counts from 1995 to 2010 were acquired for the tetracycline and sulfonamide-trimethoprim groups of antimicrobials, and from 2001 to 2010 for the 'other' antimicrobial group. Linear mixed models were produced to assess differences among provinces and over time while accounting for repeated measurements. Prescription rate, defined daily dose per 1000 inhabitant-days and defined daily doses per prescription measures for the year 2009 were also compared with those reported by participating European Union countries to determine where Canadian provinces rank in terms of antimicrobial use among these countries. RESULTS: Prescribing of all three groups varied according to province and over time. Tetracycline and sulfonamide-trimethoprim group prescribing were significantly reduced over the study period, by 36% and 61%, respectively. Prescribing of the 'other' antimicrobial group increased in all provinces from 2001 to 2010 with the exception of Prince Edward Island, although by varying amounts (10% to 61% increases). DISCUSSION: The overall use of antimicrobials in Canada has dropped from 1995 to 2010, and the tetracycline and sulfonamide-trimethoprim groups have contributed to this decline. The use of the 'other' antimicrobials has increased, however. These results may suggest that switches are being made among these groups, particularly among the antimicrobials used to treat urinary tract infections.

INTRODUCTION: Il est important de surveiller le volume et le mode d'utilisation des antimicrobiens compte tenu de la résistance antimicrobienne. OBJECTIF: Évaluer l'utilisation de trois groupes d'antimicrobiens, soit la tétracycline, la sulfonamide-triméthoprime et d'« autres ¼ antimicrobiens dans les provinces canadiennes au fil du temps. MÉTHODOLOGIE: Les chercheurs ont obtenu le nombre de prescriptions des groupes de tétracycline et de sulfonamide-triméthoprime entre 1995 et 2010 et du groupe d'« autres ¼ antimicrobiens entre 2001 et 2010. Ils ont produit des modèles linéaires mixtes pour évaluer les différences entre les provinces et dans le temps tout en tenant compte des mesures répétées. Ils ont également comparé le taux de prescriptions, les doses quotidiennes définies par 1 000 habitants-jours et les doses quotidiennes définies par mesures de prescription à ceux des pays participants de l'Union européenne en 2009 pour déterminer le classement des provinces canadiennes en matière d'utilisation d'antimicrobiens au sein de ces pays. RÉSULTATS: Les prescriptions des trois groupes de médicaments variaient selon la province et dans le temps. La prescription des groupes de tétracycline et de sulfonamide-triméthoprime a diminué considérablement pendant la période de l'étude, soit de 36 % et de 61 %, respectivement. La prescription du groupe d'« autres ¼ antimicrobiens a augmenté dans toutes les provinces entre 2001 et 2010, à l'exception de l'Île-du-Prince-Édouard, mais selon des taux différents (augmentations de 10 % à 61 %). EXPOSÉ: L'utilisation globale d'antimicrobiens a diminué au Canada entre 1995 et 2010, et les groupes de tétracycline et de sulfonamide-triméthoprime y ont contribué. L'utilisation d'« autres ¼ antimicrobiens a toutefois augmenté. Ces résultats laissent peut-être supposer des substitutions entre ces groupes, notamment entre les antimicrobiens utilisés pour soigner les infections urinaires.

Antimicrobial susceptibility of Escherichia coli F4, Pasteurella multocida, and Streptococcus suis isolates from a diagnostic veterinary laboratory and recommendations for a surveillance system.

Antimicrobial susceptibility data on Escherichia coli F4, Pasteurella multocida, and Streptococcus suis isolates from Ontario swine (January 1998 to October 2010) were acquired from a comprehensive diagnostic veterinary laboratory in Ontario, Canada. In relation to the possible development of a surveillance system for antimicrobial resistance, data were assessed for ease of management, completeness, consistency, and applicability for temporal and spatial statistical analyses. Limited farm location data precluded spatial analyses and missing demographic data limited their use as predictors within multivariable statistical models. Changes in the standard panel of antimicrobials used for susceptibility testing reduced the number of antimicrobials available for temporal analyses. Data consistency and quality could improve over time in this and similar diagnostic laboratory settings by encouraging complete reporting with sample submission and by modifying database systems to limit free-text data entry. These changes could make more statistical methods available for disease surveillance and cluster detection.

Sensibilité antimicrobienne des isolats d'Escherichia coliF4, dePasteurella multocidaet deStreptococcus suistransmise par un laboratoire de diagnostic vétérinaire et recommandations pour un système de surveillance. Les données de sensibilité antimicrobienne sur les isolats d'Escherichia coli F4, de Pasteurella multocida et de Streptococcus suis provenant des porcs de l'Ontario (de janvier 1998 à octobre 2010) ont été acquises auprès d'un laboratoire de diagnostic vétérinaire complet situé en Ontario, au Canada. En relation avec la création éventuelle d'un système de surveillance pour l'antibiorésistance, des données ont été évaluées pour déterminer la facilité de gestion, l'intégralité, la cohérence et l'applicabilité des analyses temporelles et spatiales. Des données limitées sur l'emplacement de la ferme empêchaient des analyses spatiales et des données démographiques manquantes limitaient leur utilisation comme prédicteurs au sein de modèles statistiques multivariables. Les changements du groupe standard d'antimicrobiens utilisés pour les tests de sensibilité ont réduit le nombre d'antimicrobiens disponibles pour des analyses temporelles. La cohérence et la qualité des données pourraient être améliorées au fil du temps dans ce laboratoire de diagnostic et d'autres installations semblables en encourageant la production de rapports complets avec la soumission d'échantillons et en modifiant les systèmes des bases de données afin de limiter l'entrée de données en forme libre. Ces changements pourraient rendre d'autres méthodes statistiques disponibles pour la surveillance des maladies et la détection de grappes.(Traduit par Isabelle Vallières).

Multiple-class antimicrobial resistance surveillance in swine Escherichia coli F4, Pasteurella multocida and Streptococcus suis isolates from Ontario and the impact of the 2004-2006 Porcine Circovirus type-2 Associated Disease outbreak.

The objective of this work was to describe trends in multiple-class antimicrobial resistance present in clinical isolates of Escherichia coli F4, Pasteurella multocida and Streptococcus suis from Ontario swine 1998-2010. Temporal changes in multiple-class resistance varied by the pathogens examined; significant yearly changes were apparent for the E. coli and P. multocida data. Although not present in the E. coli data, significant increases in multiple-class resistance within P. multocida isolates occurred from 2003 to 2005, coinciding with the expected increase in antimicrobials used to treat clinical signs of Porcine Circovirus Associated Disease (PCVAD) before it was confirmed. Prospective temporal scan statistics for multiple-class resistance suggest that significant clusters of increased resistance may have been found in the spring of 2004; months before the identification of the PCVAD outbreak in the fall of 2004.

Describing antimicrobial use and reported treatment efficacy in Ontario swine using the Ontario Swine Veterinary-based Surveillance program.

BACKGROUND: The objective of this work was to retrospectively assess records received through the Ontario Swine Veterinary-based Surveillance program July 2007 - July 2009 to describe and assess relationships between reported treatment failure, antimicrobial use, diagnosis and body system affected. RESULTS: Antimicrobial use occurred in 676 records, 80.4% of all records recording treatment (840). The most commonly used antimicrobials were penicillin (34.9%), tetracyclines (10.7%) and ceftiofur (7.8%), and the use of multiple antimicrobials occurred in 141/676 records (20.9%). A multi-level logistic regression model was built to describe the probability of reported treatment failure. The odds of reported treatment failure were significantly reduced if the record indicated that the gastro-intestinal (GI) system was affected, as compared to all other body systems (p < 0.05). In contrast, the odds of reported treatment failure increased by 1.98 times if two antimicrobials were used as compared to one antimicrobial (p = 0.009) and by 6.52 times if three or more antimicrobials were used as compared to one antimicrobial (p = 0.005). No significant increase in reported treatment failure was seen between the use of two antimicrobials and three or more antimicrobials. No other antimicrobials were significantly associated with reported treatment failure after controlling for body system and the number of antimicrobials used. CONCLUSIONS: Failure of antimicrobial treatment is more likely to occur in non-GI conditions, as compared to GI conditions and the use of multiple antimicrobial products is also associated with an increased probability of antimicrobial treatment failure. The authors suggest that a more preventative approach to herd health should be taken in order to reduce antimicrobial inputs on-farm, including improved immunity via vaccination, management and biosecurity strategies. Furthermore, improved immunity may be viewed as a form of antimicrobial stewardship to the industry by reducing required antimicrobial inputs and consequently, reduced selection pressure for AMR.

Declines in outpatient antimicrobial use in Canada (1995-2010).

BACKGROUND: With rising reports of antimicrobial resistance in outpatient communities, surveillance of antimicrobial use is imperative for supporting stewardship programs. The primary objective of this article is to assess the levels of antimicrobial use in Canada over time. METHODS: Canadian antimicrobial use data from 1995 to 2010 were acquired and assessed by four metrics: population-adjusted prescriptions, Defined Daily Doses, spending on antimicrobials (inflation-adjusted), and average Defined Daily Doses per prescription. Linear mixed models were built to assess significant differences among years and antimicrobial groups, and to account for repeated measurements over time. Measures were also compared to published reports from European countries. RESULTS: Temporal trends in antimicrobial use in Canada vary by metric and antimicrobial grouping. Overall reductions were seen for inflation-adjusted spending, population-adjusted prescription rates and Defined Daily Doses, and increases were observed for the average number of Defined Daily Doses per prescription. The population-adjusted prescription and Defined Daily Doses values for 2009 were comparable to those reported by many European countries, while the average Defined Daily Dose per prescription for Canada ranked high. A significant reduction in the use of broad spectrum penicillins occurred between 1995 and 2004, coupled with increases in macrolide and quinolone use, suggesting that replacement of antimicrobial drugs may occur as new products arrive on the market. CONCLUSIONS: There have been modest decreases of antimicrobial use in Canada over the past 15 years. However, continued surveillance of antimicrobial use coupled with data detailing antimicrobial resistance within bacterial pathogens affecting human populations is critical for targeting interventions and maintaining the effectiveness of these products for future generations.