1Department of Microbiology and Infectious Disease,Université de Sherbrooke,Sherbrooke,Quebec,Canada.
2Sunnybrook Health Sciences Centre,Toronto,Ontario,Canada.
Infect Control Hosp Epidemiol. 2019 Jan;40(1):53-59. doi: 10.1017/ice.2018.279. Epub 2018 Nov 5.
Point-prevalence surveys for infection or colonization with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae (CREs), and for Clostridium difficile infection (CDI) were conducted in Canadian hospitals in 2010 and 2012 to better understanding changes in the epidemiology of antimicrobial-resistant organisms (AROs), which is crucial for public health and care management.
A third survey of the same AROs in adult inpatients in Canadian hospitals with ≥50 beds was performed in February 2016. Data on participating hospitals and patient cases were obtained using standard criteria and case definitions. Associations between ARO prevalence and institutional characteristics were assessed using logistic regression models.
In total, 160 hospitals from 9 of the 10 provinces with 35,018 adult inpatients participated in the survey. Median prevalence per 100 inpatients was 4.1 for MRSA, 0.8 for VRE, 1.1 for CDI, 0.8 for ESBLs, and 0 for CREs. No significant change occurred compared to 2012. CREs were reported from 24 hospitals (15%) in 2016 compared to 10 hospitals (7%) in 2012. Routine universal or targeted admission screening for VRE decreased from 94% in 2010 to 74% in 2016. Targeted screening for MRSA on admission was associated with a lower prevalence of MRSA infection. Large hospitals (>500 beds) had higher prevalences of CDI.
This survey provides national prevalence rates for AROs in Canadian hospitals. Changes in infection control and prevention policies might lead to changes in the epidemiology of AROs and our capacity to detect them.
2010 年和 2012 年，加拿大的医院对耐甲氧西林金黄色葡萄球菌（MRSA）、万古霉素耐药肠球菌（VRE）、产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌、碳青霉烯类耐药肠杆菌科细菌（CRE）和艰难梭菌感染（CDI）进行了患病率调查，以更好地了解抗菌药物耐药生物体（ARO）的流行病学变化，这对于公共卫生和医疗管理至关重要。
2016 年 2 月，对加拿大 50 张以上病床的成年住院患者进行了相同 ARO 的第三次调查。使用标准标准和病例定义获取有关参与医院和患者病例的数据。使用逻辑回归模型评估 ARO 患病率与机构特征之间的关联。
共有来自 10 个省份中的 9 个省份的 160 家医院和 35018 名成年住院患者参与了调查。每 100 名住院患者的中位数患病率为 4.1 的 MRSA、0.8 的 VRE、1.1 的 CDI、0.8 的 ESBL 和 0 的 CRE。与 2012 年相比，没有明显变化。2016 年，24 家医院（15%）报告了 CRE，而 2012 年为 10 家医院（7%）。2010 年，94%的医院进行了常规的普遍或目标性入院筛查，而 2016 年降至 74%。入院时针对 MRSA 的目标筛查与较低的 MRSA 感染率相关。床位大于 500 张的大型医院 CDI 患病率较高。
本调查提供了加拿大医院 ARO 的全国患病率。感染控制和预防政策的变化可能导致 ARO 的流行病学变化以及我们检测它们的能力。
