Results from the Canadian Nosocomial Infection Surveillance Program on Carbapenemase-Producing Enterobacteriaceae, 2010 to 2014.
Carbapenemase-producing Enterobacteriaceae (CPE) are increasing globally; here we report on the investigation of CPE in Canada over a 5-year period. Participating acute care facilities across Canada submitted carbapenem-nonsusceptible Enterobacteriaceae from 1 January 2010 to 31 December 2014 to the National Microbiology Laboratory. All CPE were characterized by antimicrobial susceptibilities, pulsed-field gel electrophoresis, multilocus sequence typing, and plasmid restriction fragment length polymorphism analysis and had patient data collected using a standard questionnaire. The 5-year incidence rate of CPE was 0.09 per 10,000 patient days and 0.07 per 1,000 admissions. There were a total of 261 CPE isolated from 238 patients in 58 hospitals during the study period. blaKPC-3(64.8%) and blaNDM-1(17.6%) represented the highest proportion of carbapenemase genes detected in Canadian isolates. Patients who had a history of medical attention during international travel accounted for 21% of CPE cases. The hospital 30-day all-cause mortality rate for the 5-year surveillance period was 17.1 per 100 CPE cases. No significant increase in the occurrence of CPE was observed from 2010 to 2014. Nosocomial transmission of CPE, as well as international health care, is driving its persistence within Canada.
Antimicrobial Resistance and Nosocomial Infections, Public Health Agency of Canada, Winnipeg, MB, Canada.
Laura F
LF
Mataseje
Center for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON, Canada.
Kahina
K
Abdesselam
Center for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON, Canada.
Julie
J
Vachon
Center for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON, Canada.
Robyn
R
Mitchel
Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada.
Elizabeth
E
Bryce
Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada.
Diane
D
Roscoe
Antimicrobial Resistance and Nosocomial Infections, Public Health Agency of Canada, Winnipeg, MB, Canada.
David A
DA
Boyd
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
Joanne
J
Embree
Department of Infection Prevention and Control, North York General Hospital, Toronto, ON, Canada.
Kevin
K
Katz
Department of Laboratory Medicine, Victoria General Hospital, Victoria, BC, Canada.
Pamela
P
Kibsey
Department of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Andrew E
AE
Simor
Department of Infectious Diseases, University of Alberta Hospital, Edmonton, AB, Canada.
Geoffrey
G
Taylor
Department of Medical Microbiology, Hotel-Dieu de Quebec du CHUQ, QC, Canada.
Nathalie
N
Turgeon
Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada.
Joanne
J
Langley
Center for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON, Canada.
Denise
D
Gravel
Center for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON, Canada.
Kanchana
K
Amaratunga
Antimicrobial Resistance and Nosocomial Infections, Public Health Agency of Canada, Winnipeg, MB, Canada michael.mulvey@phac-aspc.gc.ca.
Michael R
MR
Mulvey
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics* / Q000378:metabolism; D002170:Canada / Q000453:epidemiology; D015780:Carbapenems / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D016521:Electrophoresis, Gel, Pulsed-Field; D004755:Enterobacteriaceae / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D015870:Gene Expression; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D010957:Plasmids / Q000737:chemistry / Q000378:metabolism*; D012150:Polymorphism, Restriction Fragment Length; D015995:Prevalence; D062486:Public Health Surveillance; D016019:Survival Analysis; D014195:Travel / Q000706:statistics & numerical data; D018440:beta-Lactam Resistance / Q000235:genetics*; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase