|
||||||
|
||||||
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
||||||
|
||||||
 |
|
|
 |
Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS)
SummaryThe Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) was developed in response to recommendations of the 2002 Health Canada Advisory Committee on Animal Uses of Antimicrobials and Impact on Resistance and Human Health. Modeled after initiatives in the United States and Europe, CIPARS has been designed to provide an ongoing, permanent, national surveillance system to monitor antimicrobial resistance trends among selected enteric organisms from humans, animals and animal-derived food sources across Canada. Antimicrobial use monitoring is also being undertaken to aid interpretation of antimicrobial resistance surveillance data from human and animal sources. This information is crucial to the development and evaluation of prudent-use policies and other risk management strategies. This publication represents the second annual CIPARS report, now being released under the auspices of the newly formed Public Health Agency of Canada. CIPARS ActivitiesThe abattoir surveillance component involves the collection and analysis of isolates of generic Escherichia coli (E. coli) and Salmonella from the intestinal (caecal) contents of healthy animals at slaughter across Canada. The retail surveillance component involves the collection and analysis of isolates of generic E. coli, Salmonella, and Campylobacter from retail meat in Ontario and Quebec. These active agri-food surveillance activities provide an indirect measure of potential human exposure to resistance arising from the consumption of animal products. CIPARS also includes passive surveillance of antimicrobial resistance (AMR) in Salmonella from human and diseased animal specimens collected in 2003 from laboratories across Canada. As the widespread use of antimicrobials is considered to be a major contributor to antimicrobial resistance, analysis of human antimicrobial use data from IMS Health is contained in this report. Future reports will provide information on antimicrobial use in animals. The antimicrobials used in animals that are of most importance to human health include the fluoroquinolones and cephalosporins. 2003 CIPARS ResultsAgri-food Surveillance : Generic E. coli from abattoir samples showed
resistance to 1 or more antimicrobials in 88% of swine, 84% of chicken,
and 34% of cattle isolates. These results did not differ significantly
from those found in 2002. No resistance was observed to fluoroquinolones,
but there was resistance to ceftiofur in 26 chicken (17%) and 2 cattle
(1%) E. coli isolates. In the case of Salmonella, 41% of isolates from
chickens and 49% from swine were resistant to 1 or more antimicrobials.
One Salmonella isolate (0.3%) from swine and 8 (6%) from chickens were
resistant to ceftiofur; 1 isolate from chickens (0.8%) was resistant
to ceftriaxone. In the case of Salmonella, ceftiofur resistance was detected in 3 Ontario (12%) and 14 Quebec isolates (50%) from chicken. For Campylobacter isolates from chicken, 56 from Ontario (72%) and 74 from Quebec (79%) were resistant to one or more antimicrobials. In particular, 3 Campylobacter isolates (4%) from Ontario and 3 from Quebec (3%) were resistant to ciprofloxacin. Provincial differences in the prevalence of resistance need to be investigated through further research and continued and expanded surveillance efforts in multiple provinces and over multiple years. With respect to passive surveillance of Salmonella in animals, clinical isolates from cattle were more frequently resistant than those isolated from other species. This reflected an outbreak of S. Newport in three Ontario dairy herds from which isolates resistant to 9 or more antimicrobials were isolated. Notably, ceftiofur resistance and reduced susceptibility to ceftriaxone was observed among 100 (43%) of all Salmonella isolates from cattle. Ceftiofur resistance was also detected in Salmonella from 2 swine (2%), 3 chicken (9%) and 6 turkey (17%) clinical isolates. Human Surveillance: A representative sample of 3056 clinical isolates from all provincial public health laboratories was collected during 2003 in order to establish a baseline for antimicrobial resistance in human Salmonella. The prevalence of resistance to 1 or more of 16 antimicrobials tested varied by serovar: 315/610 isolates (52%) of S. Typhimurium, 64/127 isolates (50%) of S. Typhi, 282/613 isolates (46%) of S. Heidelberg, 77/352 isolates (22%) of S. Enteritidis, and 28/175 isolates (16%) of S. Newport. Resistance to ceftiofur was identified in 6% of all isolates. Resistance to ceftriaxone was identified in 3/613 S. Heidelberg isolates (<1%) but reduced susceptibility to ceftriaxone was observed in a number of serovars. Two S. Typhimurium isolates (< 1%) were resistant to ciprofloxacin. The integration of the AMR information from retail meat and human surveillance highlighted that, for S. Heidelberg, resistance frequencies for most cephalosporins and for amoxicillin-clavulanic acid were in general higher among chicken than human isolates. Provincial differences observed at the retail level were also noted among human data. Comparisons of the resistance data for S. Typhimurium between the abattoir and the human components also tended to show a higher prevalence of resistance among isolates of animal than of human origin. Further characterisation of the animal, meat and human strains are needed to define the level of genetic relatedness of these strains. Human Antimicrobial Use: Analysis of IMS Health data shows that in 2003, the human systemic antibacterial classes most frequently dispensed by retail pharmacies in Canada, as a proportion of total DDDs (Defined Daily Dose), were penicillins with extended spectrum (27%), macrolides (20%), tetracyclines (14%), fluoroquinolones (12%), and first and second-generation cephalosporins (10%). After controlling for population size, systemic antibacterial use appears to have increased between 2002 and 2003, evidenced by the higher number of DDDs, prescriptions, and dollars spent; however, use in both 2002 and 2003 was lower than that observed in 2001 (with the exception of the dollars spent per inhabitant for 2003). Nevertheless, Human Health Importance Category I drugs represented an increasing proportion of the total DDDs dispensed (primarily fluoroquinolones and glycopeptides): 11.0% in 2001, 11.7% in 2002, and 12.1% in 2003. In addition to annual variations, systemic antibacterial use appeared to differ by province, season, patient sex, and patient age. Of the total number of patient visits in which sampled physicians mentioned an antimicrobial therapy between July 1, 2002 and June 30, 2003, 43% of associated diagnoses were respiratory system diseases. Conclusions and future plansCIPARS 2003 establishes baselines for AMR in selected enteric bacteria collected from healthy animals at slaughter, from retail meat, and from humans. The frequency of resistance among bacteria varied according to host and species. Multidrug-resistance in numerous Salmonella serovars and the identification of strains resistant to ciprofloxacin and the cephalosporins are of particular concern, as is the presence of fluoroquinolone resistance in Campylobacter isolated from retail chicken. CIPARS 2003 also describes patterns in human antimicrobial use. CIPARS is continuing to build the framework and partnerships for collection of relevant and representative antimicrobial resistance data along the food chain. Future plans include the expansion of retail surveillance to other provinces, the addition of other relevant bacterial species and food-producing commodities, and the inclusion of farm-level data collection. Opportunities continue to be explored to resolve barriers to collection of antimicrobial use data in food-producing animals. Continued AMR surveillance and concomitant monitoring of antimicrobial use will permit analysis of temporal trends and correlations among livestock and human populations. In future, more CIPARS data will be available to support enhanced analysis and guide further research and risk assessment studies. Collectively, these activities will elucidate factors in the development and spread of AMR along the food chain and inform risk management decisions. |
 |
Canadian
Integrated Program for
|
|
|||
|
Last Updated: 2005-04-28 |  |
|
