Real-world evidence of sotrovimab effectiveness for preventing severe outcomes in patients with COVID-19: A quality improvement propensity matched retrospective cohort study of a pan-provincial program in Alberta, Canada.

OBJECTIVE: Post-marketing surveillance of sotrovimab's effect during implementation in the Canadian population is limited. METHODS: The study used a propensity score matched retrospective cohort design. Follow-up began between the periods of December 15, 2021 to April 30 2022. The study assessed any severe outcome defined as all-cause hospital admission, or mortality within 30 days of a confirmed COVID-19 positive test. Covariate adjusted odds ratios between sotrovimab treatment and the severe outcome was conducted using logistic regression. RESULTS: There were 22,289 individuals meeting treatment criteria for sotrovimab. There were 1,603 treated and 6,299 untreated individuals included in the analysis. Outcome occurrence in the study was 5.49% (treated) and 4.21% (untreated), with a median time from diagnosis to treatment of 1.00 days (IQR = 2.00 days). In the propensity-matched cohort, sotrovimab was not associated with a lower odds of a severe outcome (OR = 1.20; 95% CI: 0.91, 1.58), adjusting for confounding variables. CONCLUSION: After adjusting for confounding variables, sotrovimab treatment was not associated with lower odds of a severe outcome within 30-days of COVID-19 positive date.

Rotating opportunistic prevalence audit: A new pragmatic audit method is effective at identifying misuse of ciprofloxacin in a large academic hospital.

The rotating opportunistic prevalence audit (ROPA) methodology is described with ciprofloxacin prescriptions in adults hospitalized at a tertiary-care center. Prescription appropriateness was assessed. ROPA captured 82% of all ciprofloxacin prescriptions; 69% were inappropriate. ROPA is feasible and may overcome resource barriers of prospective audit and feedback.

Integrated surveillance of antimicrobial resistance and antimicrobial use: Evaluation of the status in Canada (2014-2019).

OBJECTIVE: Integrated surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) across One Health sectors is critically important for effective, evidence-based policy, stewardship, and control of AMR. Our objective was to evaluate progress towards achieving comprehensive, integrated AMR/AMU surveillance in Canada. MATERIALS AND METHODS: Based on an environmental scan, interviews of subject matter experts, and reports from the 2014 National Collaborating Centre for Infectious Diseases and the 2016 Canadian Council of Chief Veterinary Officers, we identified 8 core surveillance requirements and their specific components; the latter were assessed using a 2-way classification matrix, with 7 common elements ranked according to development stage. RESULTS: Components that mapped to requirements of a comprehensive, fully integrated AMR/AMU surveillance system were mostly in the lowest stages of development (Exploration or Program Adoption). However, both the establishment of the Canadian AMR Surveillance System integrated reporting and expansion of existing components under the Canadian Nosocomial Infection Surveillance Program and the Canadian Integrated Program for AMR Surveillance are improvements. Regardless, obvious gaps in Canadian AMR/AMU surveillance prevent this from being a comprehensive and integrated One Health program. CONCLUSION: Action is needed in 3 crucial areas: i) development of a complete, integrated AMR/AMU surveillance program, based on current success; ii) changes in Federal/Provincial/Territorial policies to require standardized AMR/AMU reporting; and iii) more resources for AMR/AMU surveillance (dedicated persons, funding, and enabling structures and policy). There is an urgent need for prioritization by Federal/Provincial/Territorial governments to address governance, leadership, and funding to create surveillance systems that inform stewardship and policy.

OBJECTIF: La surveillance intégrée de la résistance aux antimicrobiens (RAM) et de l'utilisation des antimicrobiens (UAM) dans les secteurs Une seule santé est d'une importance cruciale pour une politique, une gestion et une maitrise efficaces et fondées sur des preuves de la résistance aux antimicrobiens. Notre objectif était d'évaluer les progrès vers la réalisation d'une surveillance complète et intégrée de la RAM/UAM au Canada. MÉTHODES: Sur la base d'une analyse de l'environnement, d'entrevues d'experts en la matière et de rapports du Centre de collaboration nationale des maladies infectieuses de 2014 et du Conseil canadien des chefs vétérinaires de 2016, nous avons identifié huit exigences de surveillance de base et leurs composantes spécifiques ; ces derniers ont été évalués à l'aide d'une matrice de classification à deux voies, avec sept éléments communs classés selon le stade de développement. RÉSULTATS: Les composants correspondant aux exigences d'un système de surveillance de la RAM/UAM complet et entièrement intégré en étaient pour la plupart aux stades les plus bas de développement (Exploration ou Adoption de programme). Cependant, l'établissement du Système canadien de surveillance de la RAM et l'expansion des éléments existants dans le cadre du Programme canadien de surveillance des infections nosocomiales et du Programme intégré canadien de surveillance de la RAM constituent des améliorations. Quoi qu'il en soit, des lacunes évidentes dans la surveillance canadienne de la RAM/UAM l'empêchent d'être un programme Une seule santé complet et intégré. CONCLUSION: Des actions sont nécessaires dans trois domaines cruciaux : 1) le développement d'un programme de surveillance complet et intégré de la RAM/AMU, basé sur le succès actuel; 2) des changements aux politiques fédéralesprovinciales-territoriales pour exiger des rapports normalisés sur la RAM/UAM; et 3) davantage de ressources pour la surveillance de la RAM/UAM (personnes dédiées, financement, structures et politiques habilitantes). Il est urgent que les gouvernements fédéral-provincial-territorial établissent des priorités pour aborder la gouvernance, le leadership et le financement afin de créer des systèmes de surveillance qui éclairent la gouvernance et les politiques.(Traduit par Dr Serge Messier).

Integrated surveillance of antimicrobial resistance and antimicrobial use: Evaluation of the status in Canada (2014-2019).

OBJECTIVE: Integrated surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) across One Health sectors is critically important for effective, evidence-based policy, stewardship, and control of AMR. Our objective was to evaluate progress towards achieving comprehensive, integrated AMR/AMU surveillance in Canada. MATERIALS AND METHODS: Based on an environmental scan, interviews of subject matter experts, and reports from the 2014 National Collaborating Centre for Infectious Diseases and the 2016 Canadian Council of Chief Veterinary Officers, we identified 8 core surveillance requirements and their specific components; the latter were assessed using a 2-way classification matrix, with 7 common elements ranked according to development stage. RESULTS: Components that mapped to requirements of a comprehensive, fully integrated AMR/AMU surveillance system were mostly in the lowest stages of development (Exploration or Program Adoption). However, both the establishment of the Canadian AMR Surveillance System integrated reporting and expansion of existing components under the Canadian Nosocomial Infection Surveillance Program and the Canadian Integrated Program for AMR Surveillance are improvements. Regardless, obvious gaps in Canadian AMR/AMU surveillance prevent this from being a comprehensive and integrated One Health program. CONCLUSION: Action is needed in 3 crucial areas: i) development of a complete, integrated AMR/AMU surveillance program, based on current success; ii) changes in Federal/Provincial/Territorial policies to require standardized AMR/AMU reporting; and iii) more resources for AMR/AMU surveillance (dedicated persons, funding, and enabling structures and policy). There is an urgent need for prioritization by Federal/Provincial/Territorial governments to address governance, leadership, and funding to create surveillance systems that inform stewardship and policy.

RéSUMé: OBJECTIF: La surveillance intégrée de la résistance aux antimicrobiens (RAM) et de l'utilisation des antimicrobiens (UAM) dans les secteurs Une seule santé est d'une importance cruciale pour une politique, une gestion et une maitrise efficaces et fondées sur des preuves de la résistance aux antimicrobiens. Notre objectif était d'évaluer les progrès vers la réalisation d'une surveillance complète et intégrée de la RAM/UAM au Canada. MéTHODES: Sur la base d'une analyse de l'environnement, d'entrevues d'experts en la matière et de rapports du Centre de collaboration nationale des maladies infectieuses de 2014 et du Conseil canadien des chefs vétérinaires de 2016, nous avons identifié huit exigences de surveillance de base et leurs composantes spécifiques; ces derniers ont été évalués à l'aide d'une matrice de classification à deux voies, avec sept éléments communs classés selon le stade de développement. RéSULTATS: Les composants correspondant aux exigences d'un système de surveillance de la RAM/UAM complet et entièrement intégré en étaient pour la plupart aux stades les plus bas de développement (Exploration ou Adoption de programme). Cependant, l'établissement du Système canadien de surveillance de la RAM et l'expansion des éléments existants dans le cadre du Programme canadien de surveillance des infections nosocomiales et du Programme intégré canadien de surveillance de la RAM constituent des améliorations. Quoi qu'il en soit, des lacunes évidentes dans la surveillance canadienne de la RAM/UAM l'empêchent d'être un programme Une seule santé complet et intégré. CONCLUSION: Des actions sont nécessaires dans trois domaines cruciaux : 1) le développement d'un programme de surveillance complet et intégré de la RAM/AMU, basé sur le succès actuel; 2) des changements aux politiques fédérales/provinciales/territoriales pour exiger des rapports normalisés sur la RAM/UAM; et 3) davantage de ressources pour la surveillance de la RAM/UAM (personnes dédiées, financement, structures et politiques habilitantes). Il est urgent que les gouvernements fédéral/provincial/territorial établissent des priorités pour aborder la gouvernance, le leadership et le financement afin de créer des systèmes de surveillance qui éclairent la gouvernance et les politiques.

One Health Evaluation of Antimicrobial Use and Resistance Surveillance: A Novel Tool for Evaluating Integrated, One Health Antimicrobial Resistance and Antimicrobial Use Surveillance Programs.

We describe the development, application and utility of our novel, One Health Evaluation of Antimicrobial Use and Resistance Surveillance (OHE-AMURS) tool that we created to evaluate progress toward integrated, One Health surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) as a complex system in Canada. We conducted a qualitative inquiry into the current state of policy and programs for integrated AMR/AMU surveillance using explicit and tacit knowledge. To assess the "messy" state of public health surveillance program development, we synthesized recommendations from previous reports by the National Collaborating Centre for Infectious Diseases and the Canadian Council of Chief Veterinary Officers; conducted an environmental scan to find all federal, provincial, and territorial AMR/AMU surveillance programs in Canada; and conducted semi-structured interviews with Canadian subject matter experts. To integrate evidence from these different sources we adapted two published tools to create a new evaluation matrix, deriving 36 components of the ideal integrated AMR/AMU surveillance system. Our two-way matrix tool allowed us to examine seven common, foundational elements of sustainable programs for each component, and assign a stage of development/sustainability ranking for each component according to the matrix definitions. Our adaptable novel tool allowed for granular and repeatable assessment of the many components of a complex surveillance system. The assessment proved robust and exacting to ensure transparency in our methods and results. The matrix allows flexible assignment of program components based on program principles, and stages can be adapted to evaluate any aspect of an AMR/AMU surveillance or other multi-faceted, multi-jurisdictional system. Future refinement should include an assessment of the scope of surveillance components.

Antimicrobial stewardship in rural nursing homes: Impact of interprofessional education and clinical decision tool implementation on urinary tract infection treatment in a cluster randomized trial.

OBJECTIVES: To measure the impact of an antimicrobial stewardship initiative on the rate of urine culture testing and antimicrobial prescribing for urinary tract infections (UTIs) between control and intervention sites. Secondary objectives included evaluation of potential harms of the intervention and identifying characteristics of the population prescribed antimicrobials for UTI. DESIGN: Cluster randomized controlled trial. SETTING: Nursing homes in rural Alberta, Canada. PARTICIPANTS: The study included 42 nursing homes ranging from 8 to 112 beds.Methods/interventions:Intervention sites received on-site staff education, physician academic detailing, and integrated clinical decision-making tools. Control sites provided standard care. Data were collected for 6 months prior to and 12 months after the intervention. RESULTS: Resident age (83.0 vs 83.8 years) and sex distribution (female, 62.5% vs 64.5%) were similar between the groups. Statistically significant decreases in the rate of urine culture testing (-2.1 tests per 1,000 resident days [RD]; 95% confidence interval [CI], -2.5 to -1.7; P < .001) and antimicrobial prescribing for UTIs (-0.7 prescriptions per 1,000 RD; 95% CI, -1.0 to -0.4; P < .001) were observed in the intervention group. There was no difference in hospital admissions (0.00 admissions per 1,000 RD; 95% CI, -0.4 to 0.3; P = .76), and the mortality rate decreased by 0.2 per 1,000 RD in the intervention group (95% CI, -0.5 to -0.1; P = .002). Chart reviews indicated that UTI symptoms were charted in 16% of cases and that urine culture testing occurred in 64.5% of cases. CONCLUSION: A multimodal antimicrobial stewardship intervention in rural nursing homes significantly decreased the rate of urine culture testing and antimicrobial prescriptions for UTI, with no increase in hospital admissions or mortality.