Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS)

Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) 2002 - full report 969 KB, 90 pages, in PDF format  Erratum (August, 2004) For more information please email cipars-picra@hc-sc.gc.ca

Executive Summary

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The Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) was developed as a coordinated suite of demonstration projects in order to test the feasibility of a representative and methodologically unified surveillance system. CIPARS is modeled after initiatives in the United States and Europe for monitoring trends in antimicrobial use and the development of resistance in selected bacterial organisms from human, animal and food sources across Canada. These data are crucial for making regulatory decisions or formulating intervention strategies to contain antimicrobial resistance.

The 2002 CIPARS report provides the most current, valid and representative data. It includes a relevant summary of the 1993-2001 passive surveillance data on Salmonella and Shigella from human clinical cases, active surveillance data collected from abattoirs across Canada, a summary of the 1999-2002 passive surveillance data on Salmonella from animal clinical specimens, and statistics on human antimicrobial use from IMS Health. At the time of this report, data were not yet available from CIPARS active surveillance programs to describe resistance (AMR) in human Salmonella isolates or antimicrobial use in animals. Aspects of these will be included in the 2003 CIPARS report.

Health Canada conducted a retrospective analysis of passive laboratory data on Salmonella and Shigella as an initial step to estimate the burden of AMR among human enteric pathogens. Although the differing laboratory methods for bacterial isolation and testing antimicrobial susceptibility might result in biased estimates, there was an indication that resistance may be increasing among certain strains of Salmonella. Reasons for this observation are unknown and may be reflective of individual exposure to antimicrobials, consumption of contaminated food products, or exposure during international travel. To facilitate future analyses, a baseline evaluation of human consumption of antimicrobials has been conducted. In order to standardize reporting of results, data are reported in defined daily doses.

To provide an indirect measure of potential human exposure to antimicrobial resistance arising from consumption of animal-derived products, generic Escherichia coli and Salmonella were recovered from the intestinal (cecal) contents of healthy animals at slaughter. This sampling was designed to provide estimates of the proportion of bacteria recovered with resistance or decreased susceptibility to the antimicrobials tested. It was not designed to provide estimates of the prevalence of bacterial contamination of meat at slaughter. Abattoir data collected September - December 2002 showed resistance to one or more antimicrobials in 80%, 79% and 31% of generic E. coli isolated from chicken, swine and cattle respectively. Forty eight percent of chicken and 45% of swine Salmonella isolated from abattoir samples were resistant to one or more antimicrobials. For antimicrobials of greatest importance to human health, no resistance was observed to fluoroquinolones but resistance to ceftiofur was observed in 10% of E. coli and 12% of Salmonella isolated from healthy chickens at slaughter.

These results, the observed values and the differences between species, will become more interpretable when data have been collected for several years and when concomitant antimicrobial use monitoring data become available. Future CIPARS data will permit analysis of temporal trends of use and resistance, and their correlation among livestock populations. The potential explanations for species differences include differing antimicrobial exposures, animal husbandry practices and species-specific bacterial populations. To shed more light on this complex issue, epidemiologic research is being conducted to identify risk factors for the development and spread of AMR along the food chain.

Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) 2002 - full report 969 KB, 90 pages, in PDF format