Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS): About CIPARS

On this page

• Overview
• Program objectives
• 20th year of CIPARS and beyond
• Surveillance activities
• Antimicrobial resistance
• Did you find what you were looking for?

Overview

The Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) is a national integrated surveillance program which is coordinated by the Public Health Agency of Canada's Centre for Foodborne, Environmental and Zoonotic Infectious Diseases and the National Microbiology Laboratory in collaboration with federal, provincial, and private industry partners. CIPARS collects, analyzes, and communicates trends in antimicrobial use and in antimicrobial resistance for select bacteria from humans, animals, and retail meat across Canada. The bacteria under surveillance are known as enteric bacteria (can be found in the intestines of people and animals) and can be transmitted between animals and people. Information from CIPARS supports measures to contain the emergence and spread of resistant bacteria between animals, food, and people, with the aim of prolonging the effectiveness of antimicrobials.

The program is based on several representative and methodologically unified surveillance components which can be linked to examine the relationship between antimicrobials used in food-animals and humans and the associated health impacts. This information supports: (i) the creation of evidence-based policies to control antimicrobial use in hospital, community, and agricultural settings, and thus prolong the effectiveness of these drugs, and (ii) the identification of appropriate measures to contain the emergence and spread of resistant bacteria between animals, food, and people in Canada.

CIPARS communicates annually new surveillance data through targeted communication activities and products such as the CIPARS annual stakeholder meeting's presentations, data visualizations, surveillance reports, and journal publications.

Program objectives

• Provide an integrated approach to monitor trends in antimicrobial resistance (AMR) and antimicrobial use (AMU) in humans and animals
• Help identify appropriate measures to contain the emergence and spread of resistant bacteria between animals, food, and people in Canada
• Facilitate assessment of the public health impact of antimicrobials used in humans and agriculture to support the creation of evidence-based policies to control AMU in hospital, community, and agricultural settings
• Provide timely analysis and dissemination of surveillance data to stakeholders, and facilitate knowledge translation via targeted communications products
• Allow accurate comparisons with other countries that use similar surveillance systems such as the National Antimicrobial Resistance Monitoring System (NARMS) and the Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP)
• Provision of data for Health Canada's Veterinary Drugs Directorate for new antimicrobial drug approval processes and post-approval monitoring.

20th year of CIPARS and beyond

In 2022, CIPARS marked its 20th year as a program. When CIPARS began in 2002, after years of research, it started with three antimicrobial resistance (AMR) surveillance components (abattoir, clinical isolates of sick animals and humans), the monitoring of human antimicrobial use (AMU), and several targeted research projects. After 20 years, CIPARS grew to a large multidisciplinary team with multiple AMR and AMU surveillance components, and expanded its engagement to over 900 stakeholders, contributors, and collaborators. CIPARS stakeholders use CIPARS data to inform industry-led initiatives and to track antimicrobial stewardship activities. Since 2002, CIPARS activities are making a difference in the fight on AMR!

Beyond 2022, CIPARS is looking towards expansion of the program including new surveillance components and application of whole genome sequencing, as well as innovation and optimization of communications such as additional interactive data visualizations.

Antimicrobial resistance is an urgent, global public health concern, and threatens human and animal health. Since the initiation of the program, CIPARS' goal has been working towards the preservation of effective antimicrobials for humans and animals through monitoring of trends in AMU and AMR. A key to CIPARS success since 2002 is the strong relationships between CIPARS and its stakeholders and collaborators. Their contributions to CIPARS are invaluable.

To learn more about the 20th year of CIPARS and beyond, please consult the following infographics:

• A 20-year tour
• Surveillance over the years (2002 to 2021)
• CIPARS: Working with others

Surveillance activities

CIPARS monitors trends in antimicrobial use (AMU) and antimicrobial resistance (AMR) in select bacterial species from people, animal and food sources across Canada (Figure 1).

Antimicrobial resistance: human, animal, and food surveillance

CIPARS surveillance of the human population includes passive surveillance activities for human cases of Salmonella and Campylobacter. Human cases of Salmonella and Campylobacter are nationally notifiable. Samples are collected during a medical visit and materials are submitted by provincial public laboratories to the Public Health Agency of Canada's National Microbiology Laboratory (NML) for AMR testing. CIPARS uses samples collected through FoodNet Canada for surveillance of human Campylobacter cases with testing for AMR conducted at the NML.

CIPARS surveillance in animal populations and food includes active and passive surveillance activities. Active surveillance includes samples from healthy beef cattle, dairy cattle, pigs, chickens, and turkeys along the agri-food chain (farm, abattoir, and retail) for Salmonella, E. coli, and Campylobacter. Passive surveillance includes information from Salmonella isolates submitted to provincial animal health laboratories or other laboratories (university or private laboratory) from sick animals (primarily beef cattle, dairy cattle, pigs, chickens, turkeys, and horses). Bacterial isolation (active surveillance components) and testing for AMR are conducted at the NML or other laboratories (university or private laboratory).

Antimicrobial use and sales data: Animals and crops

Starting in 2017, Health Canada regulations required manufacturers, importers and compounders to report annual sales of medically important antimicrobials intended for use in animals. To meet this requirement, the Public Health Agency of Canada and Health Canada designed and developed the online reporting tool, the Veterinary Antimicrobial Sales Reporting (VASR) system. The VASR system collects data on volumes of antimicrobials and quantity sold or compounded by animal species and by province/territory. Prior to 2019, data on antimicrobials distributed for sale for use in animals was voluntarily provided to CIPARS by the Canadian Animal Health Institute (CAHI).

Data regarding antimicrobials intended for use as pesticides on food crops are collected by Health Canada's Pest Management Regulatory Agency and are provided to CIPARS.

Fisheries and Oceans Canada under the authority of the Aquaculture Activities regulations within the Fisheries Act require industry owners and operators to report on use of drugs and pesticides, including antimicrobials. Quantities of antimicrobials are available under open data under the National Aquaculture Public Reporting Data.

CIPARS collects on-farm antimicrobial use data through questionnaires administered to volunteer sentinel farms for broiler chickens, grower-finisher pigs, and turkeys. The questionnaires are completed by the veterinarian or designated staff and are submitted to CIPARS for analysis.

Data analysis and integration

Analysis and integration of data by CIPARS include assessment and interpretation of 1) trends in antimicrobial use and resistance; 2) trends in antimicrobial resistance across bacterial species, across and within animal populations, and with human antimicrobial resistance; 3) potential links between antimicrobial use and antimicrobial resistance; and 4) the detection of new resistance, with an emphasis on critically important antimicrobials.

Engagement and reporting

Stakeholder engagement and reporting of the surveillance findings are accomplished through various stakeholder activities, communication products, and interactive visualizations.

Figure 1 - Text description

CIPARS brings together antimicrobial resistance and antimicrobial use data from various activities in humans, animals and crops.

CIPARS has passive and active surveillance activities in humans and animals (including beef cattle, dairy cattle, pigs, chickens, turkeys, and horses). Human antimicrobial resistance surveillance data is derived from human cases of Salmonella and Campylobacter infection. Animal antimicrobial resistance surveillance data includes data from healthy farm animals sampled on-farm, at the abattoir, and from retail meats. CIPARS also has surveillance activities for on-farm antimicrobial use on sentinel farms, and reports antimicrobial sales and distribution data from multiple data sources. CIPARS analysts and epidemiologists analyze and integrate antimicrobial resistance and antimicrobial use data. Stakeholder engagement and reporting of the surveillance findings are accomplished through various activities, communication products, and interactive visualizations.

Footnotes:

1 Centre for Foodborne and Environmental and Zoonotic Infectious Diseases (CFEZID), Infectious Diseases and Vaccination Programs Branch (IDVPB), Public Health Agency of Canada (PHAC)

2 One Health Division, and Division of Enteric Diseases, National Microbiology Laboratory Branch, PHAC

3 University laboratory or private laboratory

4 The Canadian Antimicrobial Resistance Surveillance System (CARSS), PHAC. Data source: IQVIA

5 Pest Management Regulatory Agency, Health Canada

6 Veterinary Antimicrobial Sales Reporting (VASR), Veterinary Drugs Directorate, Health Canada and CFEZID, PHAC

7 Fisheries and Oceans Canada

8 FoodNet Canada, CFEZID, IDVPB, PHAC

9 CIPARS engagement and reporting including: Annual Stakeholder Webinars, Integrated Findings Reports, Data Visualizations, Farm Technical Reports (including health and biosecurity data), Fact sheets, Infographics, Journal publications, VASR Highlights Reports, and CARSS Reports

Antimicrobial resistance

Antimicrobial resistance (also known as antibiotic resistance) is an urgent, global public health concern, and threatens human and animal health. Antimicrobials are medications used to treat bacterial infections. Antimicrobial resistance occurs when bacteria become resistant to these medications, and they are no longer effective in treating these infections which may lead to life-threatening or fatal antimicrobial-resistant infections. Antimicrobial resistance also threatens modern health care. Antimicrobials are important drugs for the prevention and treatment of infections following surgeries like joint replacements and cardiac procedures, or during treatments like cancer therapies. Antimicrobial resistance can lead to situations where these and other procedures or treatments cannot be performed.

Although antimicrobials are life-saving medications, any use of antimicrobials can lead to antimicrobial resistance. Antimicrobial use is widely considered a major contributor to the development of antimicrobial resistance. However, the epidemiology or causes of antimicrobial resistance are complex involving many hosts (animals, human), the environment, and numerous direct and indirect transmission pathways (Figure 2).

CIPARS is working towards the preservation of effective antimicrobials for humans and animals through monitoring trends in antimicrobial use and antimicrobial resistance.

Figure 2 - Text description

The epidemiology of antimicrobial resistance is complex involving many hosts and settings where antimicrobial resistance may emerge, persist or be transmitted (directly and indirectly). Since antimicrobial use is a major contributor to the occurrence of antimicrobial resistance, understanding its contribution to the emergence, persistence and transmission of antimicrobial resistance is important.

Host or settings where there is antimicrobial use or exposure:

• Humans (hospitalized, urban, and rural community, extended care facilities, travellers)
• Food animals (cattle, poultry, sheep, swine, veal calves, other farmed livestock)
• Companion animals (example: dogs, cats, horses, fish, others)
• Aquaculture (salmon and other finfish, crustaceans)
• Vegetation, seed crops, fruit
• Industrial and household antibacterial chemicals
• Ethanol fuel producers

Host or settings where antimicrobial resistance may emerge, persist or transmit:

• Humans (hospitalized, urban, and rural community, extended care facilities, travellers)
• Food animals (cattle, poultry, sheep, swine, veal calves, other farmed livestock, imports)
• Companion animals
• Aquaculture
• Vegetation, seed crops, fruit
• Farm effluents and manure spreading
• Animal feeds, rendering, dead stock, offal, commercial abattoirs/processing plants, retail meat, as well as handling, preparation, and consumption of food (including imported animal feed and meat products)
• Drinking water, rivers and streams, seas and lakes, swimming
• Landfill, soil, wildlife, and sewage

a This figure has elements representing 1) hosts or settings where antimicrobial resistance may emerge, persist and/or be transmitted (solid-filled circles, rectangles, squares or ovals); 2) routes of transmission of antimicrobial resistance including the direction of transmission (arrows); 3) modes of transmission (open squares); and 4) settings of antimicrobial use or exposure (solid-filled circles or ovals).

Adapted by Linton AH (1977)

Did you find what you were looking for?

To obtain additional information, please contact us by email: cipars-picra@phac-aspc.gc.ca