Mitchell Robyn, Mataseje Laura, Cayen Joëlle, McGill Erin, Cannon Kristine, Davis Ian, Duncombe Tamara, Ellis Chelsey, Ellison Jennifer, Happe Jennifer, Hota Susy S, Katz Kevin C, Kibsey Pamela, Lee Santina, Leis Jerome A, Li Xena, McGeer Allison, Minion Jessica, Musto Sonja, Patterson Connie, Rajda Ewa, Smith Stephanie W, Srigley Jocelyn A, Suh Kathryn N, Thampi Nisha, Tomlinson Jen, Vayalumkal Joseph, Versluys Kristen, Wong Titus, Longtin Yves
Public Health Agency of Canada, 130 Colonnade Road, Ottawa, ON, K1A 0K9, Canada.
National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.
Antimicrob Resist Infect Control. 2025 Jul 12;14(1):88. doi: 10.1186/s13756-025-01602-w.
Carbapenemase-producing Enterobacterales (CPE) are associated with substantial morbidity and mortality with limited treatment options and have an ability to spread rapidly in healthcare settings. We analyzed surveillance data from the Canadian Nosocomial Infection Surveillance Program to describe trends and the epidemiology of CPE from 2010 to 2023.
Participating acute-care hospitals submitted eligible isolates to the National Microbiology Laboratory for detection of carbapenemase genes. Trained infection control professionals applied standardized definitions to collect epidemiological data by chart review from 30-97 hospitals from 2010 to 2023.
The national incidence of CPE infection (0.03 to 0.14 per 10,000 patient days; R = 0.76) and colonization (0.02 to 0.78 per 10,000 patient days; R = 0.83) increased exponentially from 2010 to 2023. We identified rapidly rising rates of healthcare-associated (HA) CPE infections from 2019 to 2023 (0.05 to 0.09 per 10,000 patient-days, p = 0.04), attributed to select hospitals (7/97) which accounted for half (53%) of all HA-CPE infections in 2023. Similarly, we identified that 2023 HA-CPE colonization rates were highest in medium (201-499 beds) and large (≥500 beds) hospitals in the Central region. Most patients did not report international travel (66%) nor receipt of medical care abroad (74%). Travel and receipt of medical care were less commonly reported among bla associated cases (7.1% and 5.3% respectively) compared to bla (55% and 45% respectively) and bla (57% and 39%) associated cases. Furthermore, bla was the predominant carbapenemase among all HA-CPE isolates (62%, 950/1,534).
Surveillance data from a national network of Canadian acute care hospitals indicates that while the incidence of CPE in Canada remains low, it is accelerating at an exponential rate. Our findings suggest that nosocomial transmission is driving the recent increase in CPE incidence in Canada. Improved infection control measures and antimicrobial stewardship as well as access to newer antimicrobials are all urgently needed.
产碳青霉烯酶肠杆菌目细菌（CPE）与高发病率和死亡率相关，治疗选择有限，且有在医疗机构中迅速传播的能力。我们分析了加拿大医院感染监测项目的监测数据，以描述2010年至2023年CPE的趋势和流行病学特征。
参与的急症护理医院将符合条件的分离株提交给国家微生物实验室，以检测碳青霉烯酶基因。训练有素的感染控制专业人员应用标准化定义，通过对2010年至2023年30至97家医院的病历审查来收集流行病学数据。
2010年至2023年，全国CPE感染发病率（每10000个患者日0.03至0.14例；R = 0.76）和定植率（每10000个患者日0.02至0.78例；R = 0.83）呈指数增长。我们发现2019年至2023年医疗保健相关（HA）CPE感染率迅速上升（每10000个患者日0.05至0.09例，p = 0.04），这归因于部分医院（7/97），这些医院在2023年占所有HA-CPE感染的一半（53%）。同样，我们发现2023年中部地区中型（201 - 499张床位）和大型（≥500张床位）医院的HA-CPE定植率最高。大多数患者未报告国际旅行（66%）或在国外接受医疗（74%）。与bla相关病例（分别为55%和45%）和bla相关病例（分别为57%和39%）相比，bla相关病例中报告旅行和接受医疗的情况较少（分别为7.1%和5.3%）。此外，bla是所有HA-CPE分离株中占主导地位的碳青霉烯酶（62%，950/1534）。
来自加拿大急症护理医院全国网络的监测数据表明，虽然加拿大CPE的发病率仍然较低，但正在以指数速度加速上升。我们的研究结果表明，医院内传播是加拿大近期CPE发病率上升的原因。迫切需要改进感染控制措施、抗菌药物管理以及获取更新型抗菌药物。
