Ebrahim M, Gravel D, Thabet C, Abdesselam K, Paramalingam S, Hyson C
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON.
Can Commun Dis Rep. 2016 Nov 3;42(11):227-231. doi: 10.14745/ccdr.v42i11a02.
There is a global concern that the emergence of antimicrobial resistance (AMR) threatens our ability to treat infectious diseases. The Canadian Antimicrobial Resistance Surveillance System (CARSS) was created in response to the Government of Canada's commitment to addressing AMR. CARSS integrates information from nine different national surveillance systems for tracking antimicrobial use (AMU) and AMR in both humans and animals to inform AMU/AMR research and policy.
To provide highlights of CARSS data on antimicrobial use in humans and animals, AMR trends in human infections in both hospital and community settings and AMR bacteria found in food production animals.
Information on AMU in animals and humans is purchased and additional information on AMU in animals is collected through the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS). AMR data in humans focuses on first priority organisms. Data on priority organisms for hospital-based AMR is collected through Canadian Nosocomial Infection Surveillance Program (CNISP), Canadian Tuberculosis Laboratory Surveillance System (CTBLSS), Canadian Tuberculosis Laboratory Surveillance System (CTBRS), Canadian Tuberculosis Reporting System (CTBRS) and CIPARS. Data on community-based AMR is collected through CTBLSS, CTBRS, CIPARS, the Antimicrobial-resistant Surveillance System (ARNGSS) and the National Surveillance of Invasive Streptococcal Disease (NSISD). AMR data on animals is collected through CIPARS.
In terms of antibiotic usage in 2014, approximately 82% of antimicrobials were directed to food production animals, 18% to humans and less than one percent each to companion animals (e.g., pets) and crops. Over the past five years, 73% of antimicrobials distributed to food production animals belonged to the same classes as those used in human medicine. Antibiotic usage in humans has remained relatively stable. Trends in 2014 for AMR in hospitals include declining rates of hospital-acquired to 3.4 cases per 1,000 patient admissions, methicillin-resistant MRSA) infections to 2.89 cases per 10,000 patient days and vancomycin-resistant Enterococci (VRE) to 0.45 cases per 10,000 patient days. Resistance to a number of antimicrobials used to treat has decreased since the introduction of pneumococcal vaccine in 2010. In contrast, trends in 2014 for AMR in the community included increasing rates of community-acquired - 52.4% of isolates were resistant to at least one antibiotic. Trends for carbapenem-resistant (CRE) were stable at 0.22 cases per 10,000 patient days. Also, between 2004 and 2014, nine percent of tuberculosis (TB) culture positive cases were resistant to at least one first line anti-tuberculosis drug and this has remained relatively stable over that time. Trends in 2014 for AMR in food production animals showed decreasing resistance of and species to third-generation cephalosporins (ceftriaxone) in poultry associated with a decrease in cephalosporin use on chicken farms, but resistance to ciprofloxacin in species in chicken and cattle has been increasing.
Overall, antibiotic use in humans has not declined despite concerns about overuse. Although resistance rates of , VRE, MRSA and AMR have been gradually decreasing and drug-resistant tuberculosis and CRE have remained stable, community-associated drug-resistant has been increasing. Although efforts to decrease antibiotic use in animals have been met with some success, AMR continues to occur in fairly high levels in food production animals.
全球对抗菌药物耐药性（AMR）的出现威胁到我们治疗传染病的能力深感担忧。加拿大抗菌药物耐药性监测系统（CARSS）是为响应加拿大政府应对AMR的承诺而设立的。CARSS整合了来自九个不同国家监测系统的信息，用于跟踪人类和动物的抗菌药物使用（AMU）及AMR情况，以为AMU/AMR研究和政策提供信息。
介绍CARSS关于人类和动物抗菌药物使用、医院和社区环境中人类感染的AMR趋势以及食品生产动物中发现的AMR细菌的数据要点。
购买动物和人类AMU的信息，并通过加拿大抗菌药物耐药性综合监测计划（CIPARS）收集动物AMU的其他信息。人类AMR数据聚焦于首要重点病原体。通过加拿大医院感染监测计划（CNISP）、加拿大结核病实验室监测系统（CTBLSS）、加拿大结核病实验室监测系统（CTBRS）、加拿大结核病报告系统（CTBRS）和CIPARS收集基于医院的AMR重点病原体数据。通过CTBLSS、CTBRS、CIPARS、抗菌药物耐药性监测系统（ARNGSS）和侵袭性链球菌病国家监测（NSISD）收集基于社区的AMR数据。动物AMR数据通过CIPARS收集。
在2014年的抗生素使用方面，约82%的抗菌药物用于食品生产动物，18%用于人类，用于伴侣动物（如宠物）和农作物的各不到1%。在过去五年中，分发给食品生产动物的抗菌药物中有73%与用于人类医学的属于同一类别。人类抗生素使用一直相对稳定。2014年医院AMR的趋势包括医院获得性感染率降至每1000例患者入院3.4例，耐甲氧西林金黄色葡萄球菌（MRSA）感染率降至每10000患者日2.89例，耐万古霉素肠球菌（VRE）感染率降至每10000患者日0.45例。自2010年引入肺炎球菌疫苗以来，用于治疗的多种抗菌药物的耐药性有所下降。相比之下，2014年社区AMR的趋势包括社区获得性感染率上升——52.4%的分离株对至少一种抗生素耐药。耐碳青霉烯肠杆菌（CRE）的趋势稳定在每10000患者日0.22例。此外，在2004年至2014年期间，9%的结核病（TB）培养阳性病例对至少一种一线抗结核药物耐药，且在此期间一直相对稳定。2014年食品生产动物AMR的趋势显示，家禽中大肠杆菌和弯曲杆菌属对第三代头孢菌素（头孢曲松）的耐药性下降，这与养鸡场头孢菌素使用减少有关，但鸡和牛中弯曲杆菌属对环丙沙星的耐药性一直在增加。
总体而言，尽管存在过度使用的担忧，但人类抗生素使用并未下降。虽然大肠杆菌、VRE、MRSA和AMR肺炎球菌的耐药率一直在逐渐下降，耐多药结核病和CRE保持稳定，但社区相关耐药性肺炎球菌一直在增加。尽管减少动物抗生素使用的努力取得了一些成功，但AMR在食品生产动物中仍以相当高的水平持续存在。
