Results from the Canadian Nosocomial Infection Surveillance Program on Carbapenemase-Producing Enterobacteriaceae, 2010 to 2014
Antimicrob. Agents Chemother. November 1, 2016 V.60 N.11 P.6787-6794
Laura F. Mataseje, Kahina Abdesselam, Julie Vachon, Robyn Mitchel, Elizabeth Bryce, Diane Roscoe, David A. Boyd, Joanne Embree, Kevin Katz, Pamela Kibsey, Andrew E. Simor, Geoffrey Taylor, Nathalie Turgeon, Joanne Langley, Denise Gravel, Kanchana Amaratunga, and Michael R. Mulvey , on behalf of the Canadian Nosocomial Infection Surveillance Program
aAntimicrobial Resistance and Nosocomial Infections, Public Health Agency of Canada, Winnipeg, MB, Canada
bCenter for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON, Canada
cDepartment of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
dDepartment of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
eDepartment of Infection Prevention and Control, North York General Hospital, Toronto, ON, Canada
fDepartment of Laboratory Medicine, Victoria General Hospital, Victoria, BC, Canada
gDepartment of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
hDepartment of Infectious Diseases, University of Alberta Hospital, Edmonton, AB, Canada
iDepartment of Medical Microbiology, Hotel-Dieu de Quebec du CHUQ, QC, Canada
jDepartment of Pediatrics, IWK Health Centre, Halifax, NS, Canada
Carbapenemase-producing Enterobacteriaceae (CPE) are increasing globally; here we report on the investigation of CPE in Canada over a 5-year period. Participating acute care facilities across Canada submitted carbapenem-nonsusceptible Enterobacteriaceae from 1 January 2010 to 31 December 2014 to the National Microbiology Laboratory.
All CPE were characterized by antimicrobial susceptibilities, pulsed-field gel electrophoresis, multilocus sequence typing, and plasmid restriction fragment length polymorphism analysis and had patient data collected using a standard questionnaire. The 5-year incidence rate of CPE was 0.09 per 10,000 patient days and 0.07 per 1,000 admissions.
There were a total of 261 CPE isolated from 238 patients in 58 hospitals during the study period. blaKPC-3 (64.8%) and blaNDM-1 (17.6%) represented the highest proportion of carbapenemase genes detected in Canadian isolates. Patients who had a history of medical attention during international travel accounted for 21% of CPE cases.
The hospital 30-day all-cause mortality rate for the 5-year surveillance period was 17.1 per 100 CPE cases. No significant increase in the occurrence of CPE was observed from 2010 to 2014. Nosocomial transmission of CPE, as well as international health care, is driving its persistence within Canada.