title: Antimicrobial resistance and antimicrobial use associated with laboratory-confirmed cases of Campylobacter infection in two health units in Ontario.
abstract: OBJECTIVE
  A population-based study was conducted over a two-year period in the Perth District (PD) and Wellington-Dufferin-Guelph (WDG) health units in Ontario to document antimicrobial resistance and antimicrobial use associated with clinical cases of laboratory-confirmed campylobacteriosis.
  
  
  METHODS
  Etest (bioMérieux SA, France) was used to determine the minimum inhibitory concentration of amoxicillin/clavulanic acid, ampicillin, chloramphenicol, ciprofloxacin (CIP), clindamycin, erythromycin (ERY), gentamicin, nalidixic acid and tetracycline. Data regarding antimicrobial use were collected from 250 cases.
  
  
  RESULTS
  Of the 250 cases, 165 (65.7%) reported staying home or being hospitalized due to campylobacteriosis. Fifty-four per cent of cases (135 of 249) reported taking antimicrobials to treat campylobacteriosis. In 115 cases (51.1%), fecal culture results were not used for treatment decisions because they were not available before the initiation of antimicrobial treatment and/or they were not available before the cessation of symptoms. Of the 250 cases, 124 (49.6%) had available Campylobacter isolates, of which 66 (53.2%) were resistant to at least one of the antimicrobials tested. No resistance to ampicillin, chloramphenicol or gentamicin was found in these isolates. Six isolates (4.8%) were resistant to CIP. Two isolates (1.6%) were resistant to ERY; however, no isolates were resistant to both CIP and ERY.
  
  
  CONCLUSIONS
  Prudent use practices should be promoted among physicians to reduce the use of antimicrobials for the treatment of gastroenteritis in general and campylobacteriosis in particular, as well as to minimize the future development of resistance to these antimicrobials in Campylobacter species.
authors.affiliation: Department of Population Medicine, University of Guelph; ; Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Guelph;
authors.forename: Anne E
authors.initials: AE
authors.lastname: Deckert
authors.affiliation: Department of Population Medicine, University of Guelph; ; Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Guelph;
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Reid-Smith
authors.affiliation: Public Health Consultant, Stratford;
authors.forename: Susan E
authors.initials: SE
authors.lastname: Tamblyn
authors.affiliation: Perth District Health Unit, Stratford;
authors.forename: Larry
authors.initials: L
authors.lastname: Morrell
authors.affiliation: Wellington-Dufferin-Guelph District Health Unit, Guelph;
authors.forename: Patrick
authors.initials: P
authors.lastname: Seliske
authors.affiliation: Public Health Ontario, Toronto;
authors.forename: Frances B
authors.initials: FB
authors.lastname: Jamieson
authors.affiliation: Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Guelph;
authors.forename: Rebecca
authors.initials: R
authors.lastname: Irwin
authors.affiliation: Department of Population Medicine, University of Guelph;
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Dewey
authors.affiliation: Department of Pathobiology, University of Guelph, Guelph, Ontario.
authors.forename: Patrick
authors.initials: P
authors.lastname: Boerlin
authors.affiliation: Department of Population Medicine, University of Guelph;
authors.forename: Scott A
authors.initials: SA
authors.lastname: McEwen
keywords: Antimicrobial resistance; Antimicrobial use; Campylobacter; Canada; Ontario