Finding drug resistant infections in Canadian hospitals
Results from the Canadian Nosocomial Infection Surveillance Program for detection of carbapenemase-producing Acinetobacter spp. in Canadian hospitals, 2010-16. Boyd DA*, Mataseje LF*, Pelude L, Mitchell R, Bryce E, Roscoe D, Embree J, Katz K, Kibsey P, Lavallee C, Simor A, Taylor G, Turgeon N, Langley JM, Amaratunga K, Mulvey MR* on behalf of the members of the CNISP J Antimicrob Chemother 2019 Feb 1; 74(2):315-20. doi: https://doi.org/10.1093/jac/dky416
This science story highlights a success from a Canadian Nosocomial Infection Surveillance Program (CNISP) collaboration. This collaborative work to conduct surveillance of an infectious bacteria with the ability to develop antibiotic resistance promotes clinical awareness of the issue and additional research opportunities.
What was known about this area prior to your work, and why was the research done?
Acinetobacter baumannii (A. baumanniiI) is a Gram-negative bacteria which causes infections mainly in healthcare settings such as hospitals or nursing homes. There is public health concern that a growing number of Gram-negative bacteria, including A. baumannii, are becoming increasingly resistant to the antibiotics used to treat them. A. baumannii is able to rapidly develop and spread antibiotic resistance, including resistance to the last line treatment option for severe or high-risk bacterial infections, otherwise know as the drug class carbapenems. In response to the global emergence of A. baumannii, and in partnership with CNISP, the NML began to investigate carbapenem resistant A. baumannii (CRA). This study conducted surveillance of CRA between 2010 - 2016 and provided data that was limited before this work was done.
What are your most significant findings from this work?
This study confirm that CRA are rare in Canada and that incidence rates did not change significantly during 2010 – 2016. Of significance with respect to AMR, is that 78.7% of the A. baumannii studied were classified as extensively drug resistant (XDR) and were found to carry a multitude of genes causing resistance to multiple drug classes. Treatment of these bacterial infections becomes more difficult as drug options become increasingly limited with each acquired drug resistance gene. Another important finding of this study is that almost 40% of positive patients reported both travelling and receiving medical treatment outside of Canada in the last 12 months.
What are the implications or impact of the research?
While CRA rates are currently stable in Canada, CRA are highly AMR thereby making them important from a public health perspective. Continued surveillance and reporting is needed to ensure that public health can monitor the incidence of these resistant infectious bacteria. This is particularly important in light of rising global rates of CRA. Further, this study suggests that travel and receipt of medical care outside of Canada are important factors in the importation of CRA into Canada. Making healthcare professionals aware of this risk factor could help with the diagnosis and treatment of CRA.
Additional References of Significance:
- Higgins PG, Dammhayn C, Hackel M et al. Global spread of carbpenem-resistant Acinetobacter baumannii. J Antimicrob Chemother 2010 Feb; 65(2):233-8. doi: https://doi.org/10.1093/jac/dkp428
- Prioritization of pathogens to guide discovery, research and development of new antibiotics for drug resistant bacterial infections, including tuberculosis. WHO 2017; WHO/EMP/IAU/2017.12. https://www.who.int/medicines/areas/rational_use/prioritization-of-pathogens/en/
- Rello J, Eshwara VK, Lagunes L et al. A global list of the TOp TEn resistant Microorganisms (TOTEM) study at intensive care: a prioritization exercise based on multi-criteria decision analysis. Eur J Clin Microbiol Infect Dis 2019 Feb; 38(2):319-23. doi: https://doi.org/10.1007/s10096-018-3428-y
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