title: An assessment of antimicrobial resistant disease threats in Canada.
abstract: BACKGROUND
  Antimicrobial resistance (AMR) of infectious agents is a growing concern for public health organizations. Given the complexity of this issue and how widespread the problem has become, resources are often insufficient to address all concerns, thus prioritization of AMR pathogens is essential for the optimal allocation of risk management attention. Since the epidemiology of AMR pathogens differs between countries, country-specific assessments are important for the determination of national priorities.
  
  
  OBJECTIVE
  To develop a systematic and transparent approach to AMR risk prioritization in Canada.
  
  
  METHODS
  Relevant AMR pathogens in Canada were selected through a transparent multi-step consensus process (n=32). Each pathogen was assessed using ten criteria: incidence, mortality, case-fatality, communicability, treatability, clinical impact, public/political attention, ten-year projection of incidence, economic impact, and preventability. For each pathogen, each criterion was assigned a numerical score of 0, 1, or 2, and multiplied by criteria-specific weighting determined through researcher consensus of importance. The scores for each AMR pathogen were summed and ranked by total score, where a higher score indicated greater importance. A sensitivity analysis was conducted to determine the effects of changing the criteria-specific weights.
  
  
  RESULTS
  The AMR pathogen with the highest total weighted score was extended spectrum B-lactamase-producing (ESBL) Enterobacteriaceae (score=77). When grouped by percentile, ESBL Enterobacteriaceae, Clostridium difficile, carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus were in the 80-100th percentile.
  
  
  CONCLUSIONS
  This assessment provides useful information for prioritising public health strategies regarding AMR resistance at the national level in Canada. As the AMR environment and challenges change over time and space, this systematic and transparent approach can be adapted for use by other stakeholders domestically and internationally. Given the complexity of influences, resource availability and multiple stakeholders, regular consideration of AMR activities in the public health realm is essential for appropriate and responsible prioritisation of risk management that optimises the health and security of the population.
authors.affiliation: Population Health Assessment and Scenarios Team, Public Health Agency of Canada, Ottawa, Ontario, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Garner
authors.affiliation: Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Guelph, Ontario, Canada.
authors.forename: Carolee
authors.initials: C
authors.lastname: Carson
authors.affiliation: Population Health Assessment and Scenarios Team, Public Health Agency of Canada, Ottawa, Ontario, Canada.
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Lingohr
authors.affiliation: Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Guelph, Ontario, Canada.
authors.forename: Aamir
authors.initials: A
authors.lastname: Fazil
authors.affiliation: Population Health Assessment and Scenarios Team, Public Health Agency of Canada, Ottawa, Ontario, Canada.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Edge
authors.affiliation: Population Health Assessment and Scenarios Team, Public Health Agency of Canada, Ottawa, Ontario, Canada.
authors.forename: Jan
authors.initials: J
authors.lastname: Trumble Waddell
mesh_terms: D000465:Algorithms; D001424:Bacterial Infections / Q000382:microbiology*; D002170:Canada; D004352:Drug Resistance, Microbial; D004756:Enterobacteriaceae Infections / Q000453:epidemiology*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000453:epidemiology*