2004 - Full Report

For more information please email cipars-picra@hc-sc.gc.ca

Errartum :

1. Due to a pdf conversion error, page 123 (Table 42) of the English version of the CIPARS 2004 Annual report is missing the red text. Here is the corrected version: Table 42. Distribution of MICs and resistance in Campylobacter spp recovered from chicken in Ontario and Québec; Retail Surveillance 2004 .
2. The first sentence of the text box appearing on page 57 refers to "ground pork samples". This should be replaced by "pork chop samples".
3. Due to a pdf conversion error, the first sentence of the text box on page 60 of the English version is missing. The missing text is the following: "For 2004, results from Retail Surveillance showed that in Ontario 56% (31/55) and in Québec, 69%..."

Summary

CIPARS Activities

In 2004, CIPARS operated two active surveillance components:

1. abattoir surveillance involves the collection and analysis of isolates of generic Escherichia coli and Salmonella from the intestinal contents of healthy animals at slaughter across Canada; and
2. retail surveillance involves the collection and analysis of isolates of generic E. coli, Salmonella, Campylobacter, and Enterococcus from retail meat in Ontario and Québec. The 2005 CIPARS report will contain retail surveillance data from Saskatchewan. In 2006, CIPARS begins its On-Farm Surveillance component that will provide on-farm data regarding antimicrobial use and resistance among enteric bacteria using a sentinel farm framework (Box 3).

CIPARS also includes passive surveillance of antimicrobial resistance in Salmonella from human and diseased animal specimens collected from laboratories across Canada.

Human (Intercontinental Medical Statistics Health) antimicrobial use information is also incorporated into CIPARS. Antimicrobial use is a recognized risk factor for antimicrobial resistance and monitoring baseline use data is valuable to evaluate prudent use strategies and other interventions. CIPARS focuses particularly on resistance to antimicrobial classes of high human health importance (Category I) such as newer cephalosporins (e.g. ceftiofur, ceftriaxone) and fluoroquinolones (e.g. ciprofloxacin). Nalidixic acid resistance is also highlighted because it can predict reduced efficacy or clinical failure to fluoroquinolones.

2004 CIPARS Results

Agrifood Surveillance
Abattoir surveillance: Generic E. coli from abattoir samples showed resistance to one or more antimicrobials in 80% of swine, 78% of chicken, and 31% of cattle isolates. Ciprofloxacin resistance was noted in less than one percent of cattle isolates from abattoir surveillance. Resistance to ceftiofur was observed in one percent of cattle and 25% of chicken E. coli isolates, the latter representing a significant increase from 16% ceftiofur resistance observed in 2002/2003. In the case of Salmonella, 40% of isolates from chickens and 48% from swine were resistant to one or more antimicrobials. In chickens, one percent of Salmonella isolates were resistant to ceftriaxone and 13% showed reduced susceptibility to ceftriaxone. A significantly increased number of isolates were resistant to ceftiofur between 2002/2003 (7%) and 2004 (22%).

Retail surveillance: The percentage of E. coli isolates demonstrating resistance was lower overall than that seen among the abattoir samples. In 2004, resistance to ceftiofur in E. coli was highest among chicken (28% of isolates from Ontario and Québec overall), as was the case in 2003, than in other commodity. In the case of Salmonella, 63% of all chicken isolates from Ontario and Québec were resistant to one or more antimicrobials. Ceftiofur resistance was detected in 45% and 40% of chicken isolates from Ontario and Québec, respectively. For Campylobacter isolates from chicken, 53% from Ontario and 81% from Québec were resistant to one or more antimicrobials. Two percent of Campylobacter isolates from Ontario and three percent from Québec were resistant to ciprofloxacin. For Enterococcus isolates from chicken, 98% from Ontario and 94% from Québec were resistant to one or more antimicrobials. No resistance was detected in the Enterococcus isolates to ciprofloxacin, linezolid, or vancomycin. However, 100% of all E. faecium isolates from Ontario (6 isolates) and Québec (5 isolates) were resistant to quinupristine-dalfopristine.

Animal clinical isolates: Salmonella isolates from passive animal surveillance of animal clinical submissions animals that do not enter the food-chain) showed resistance to one or more antimicrobials in 83% of turkey, 77% of swine, 57% of cattle, and 40% of chicken isolates. Notably, ceftiofur resistance was observed in 21% of chicken, 20% of cattle, 17% of turkey, and 2% of swine isolates.

Human Surveillance
In 2004, 3147 Salmonella isolates from humans were collected from provincial public health laboratories. The prevalence of resistance to one or more of 16 antimicrobials tested varied by serovar: 58% - of S. Typhi isolates, 56% - of S.Heidelberg isolates, 47% - of S.Typhimurium, 29% - of S.Enteritidis, and 14% - isolates of S.Newport.

Resistance to ceftiofur was identified in seven percent of all isolates; 33% - of S.Heidelberg, nine percent - of S.Newport isolates, two percent -of S.Typhimurium isolates, and less than one percent - of S.Enteritidis isolates.

Resistance to ceftriaxone was identified in less than one percent of all isolates but reduced susceptibility was observed in six percent of all isolates. Reduced susceptibility and resistance to ceftriaxone in S.Heidelberg isolates increased significantly between 2003 (8%) and 2004 (26%). Less than one percent of S.Typhimurium isolates and one (1/5) S.Indiana isolate were resistant to ciprofloxacin, however resistance to nalidixic acid, which can predict reduced clinical efficacy of fluoroquinolones, was observed in 23% of S. Enteritidis and 57% of S. Typhi isolates.

Human Antimicrobial Use:
The human systemic antibacterial classes most frequently dispensed by retail pharmacies in Canada, as a proportion of total defined daily doses), were extended-spectrum penicillins (25%); macrolides (20%); tetracyclines (14%); fluoroquinolones (12%); and second-generation cephalosporins (5%).

Decreases were noted in the total number of prescriptions per 1000 inhabitant-years (739 in 2000 to 661 in 2004) and in the number of defined daily doses per 1000 inhabitant-days (19.23 in 2000 to 17.35 in 2004). However, despite a decrease in consumption, the amount of money spent by Canadians to purchase oral drugs through retail pharmacies increased from $20,853 per 1000 inhabitants in 2000 to $21,053 per 1000 inhabitants in 2004. This rise is attributed in part to the growing proportion of more costly Category I drugs dispensed in 2004 (12%) compared to 2000 (10%).

Antimicrobials of Very High Human Health Importance (Category I) represented a consistently increasing proportion of the total DDDs dispensed from 10% in 2000 compared to 12% in 2004.

Of the total number of patient visits in which sampled physicians mentioned an antimicrobial therapy between 2000 and 2004, 51% of associated diagnoses were respiratory system diseases. During this period, the primary antimicrobial classes mentioned during visits for respiratory disease were extended spectrum macrolides (32%), amoxicillin (25%), cephalosporins (14%) and oral quinolones (11%).

Conclusions and future plans

CIPARS 2004 data describe patterns in human antimicrobial useand antimicrobial resistance in selected enteric organisms in human and animals across Canada. Multidrug-resistance in numerous Salmonella serovars and the identification of strains resistant to ciprofloxacin and the cephalosporins are of particular concern, as is the observation of fluoroquinolone resistance in Campylobacter isolated from retail chicken (also noted in 2003). In 2003, the prevalences of resistance to beta-lactam antimicrobials was significantly higher among retail chicken and human S. Heidelberg isolates from Québec, than retail chicken and human isolates from Ontario. In 2004, although the relative frequency of this serovar, in comparison to all isolated Salmonella, decreased significantly for both retail chicken and human isolates, the prevalence of beta-lactam resistance significantly increased in Ontario in both retail chicken and human isolates to reach the same levels found in Québec.

The current lack of detailed data describing antimicrobial use in food animals limits exploration of links between antimicrobial use and resistance in livestock. The on-farm component of CIPARS being introduced in 2006 will provide useful information in this regard and assist in the development of prudent use guidelines. Other efforts are also being made by CIPARS and several provinces to obtain more detailed national or provincial animal drug use data. Antimicrobial distribution data from animals will be made available to CIPARS by the Canadian Animal Health Institute; these data will be posted on our website later in 2006.

Potential explanations for AMR differences within and between humans and animal species include differing antimicrobial exposures, animal husbandry practices, and species-specific bacterial populations. To shed more light on this complex issue, further laboratory characterization and epidemiologic research are being conducted to identify risk factors for the development and spread of antimicrobial resistance along specific points of the food chain. CIPARS integration of data over time will help to identify temporal relationships between human and animal/food data.

2004 Surveillance Report

Table of Contents

• Introduction
  • About CIPARS
  • Acknowledgements
  • Abbreviations
• List of Figures
• List of Tables
• List of Boxes
• Executive Summary
• Section One - Antimicrobial Resistance
  • Antimicrobial Resistance in Human Isolates
  • Antimicrobial Resistance in the Agri-food Sector
    • Part I - Abattoir Surveillance
    • Part II - Retail Surveillance of Food of Animal Origin
    • Part III - Passive Surveillance of Animal Clinical Isolates
  • Integrated Human and Agri-Food Antimicrobial Resistance Results
    • Antimicrobial Resistance Across Animal Species
    • Comparisons of Salmonella serovars and phage types across human, abattoir, and retail isolates
    • Antimicrobial Resistance in Bacteria Contaminating Food or Animals - A Public Health Concern?
• Section Two - Antimicrobial Use
  • Human Antimicrobial Use
  • Animal Antimicrobial Use
• Appendix A: Additional Information
  • A.1 Categorization of Antimicrobial Products Based on Importance in Human Medicine¹
  • A.2 Demographic Information
  • A.3 Human Antimicrobial Resistance
  • A.4 Agri-Food Antimicrobial Resistance
  • A.5 Antimicrobial Use - Human
• Appendix B - Methods
  • B.1 Human Antimicrobial Resistance
  • B.2 Agri-Food Antimicrobial Resistance
    • Sampling Design and Data Collection
    • Bacterial Isolation Methods
    • Serotyping, Phage Typing, and Antimicrobial Susceptibility Testing Methods
    • Quality Control Testing.
  • B.3 Human Antimicrobial Use Data Collection and Analysis
• Appendix C - References

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