Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2016–2020

Abstract

Background: Canadians experience increased morbidity, mortality and healthcare costs due to healthcare-associated infections (HAIs) and antimicrobial resistance (AMR). The Canadian Nosocomial Infection Surveillance Program (CNISP) collects and utilizes epidemiologic and laboratory surveillance data to inform infection prevention and control and antimicrobial stewardship programs and policies. The objective of this report is to describe the epidemiologic and laboratory characteristics and trends of HAIs and AMR from 2016 to 2020 using surveillance data provided by Canadian hospitals participating in the CNISP. Methods: Data were collected from 87 Canadian sentinel acute care hospitals between January 1, 2016, and December 31, 2020, for Clostridioides difficile infection (CDI), methicillinresistant Staphylococcus aureus (MRSA) bloodstream infections, vancomycin-resistant Enterococci (VRE) bloodstream infections and carbapenemase-producing Enterobacterales (CPE). Case counts, rates, outcome data, molecular characterization and antimicrobial resistance profiles are presented. Results: From 2016 to 2020, increases in rates per 10,000 patient days were observed for MRSA bloodstream infections (33%; 0.84–1.12, p=0.037), VRE bloodstream infections (72%; 0.18–0.31, p=0.327), and CPE infections (67%, 0.03–0.05, p=0.117) and colonizations (86%, 0.14–0.26, p=0.050); however, CDI rates decreased by 8.5% between 2016 and 2020 (from 5.77–5.28, p=0.050). Conclusion: Surveillance findings from a national network of Canadian acute care hospitals indicate that rates of MRSA and VRE bloodstream infections, CPE infections and colonizations have increased substantially between 2016 and 2020 while rates of CDI have decreased. The collection of detailed, standardized surveillance data and the consistent application of infection prevention and control practices in acute care hospitals are critical in reducing the burden of HAIs and AMR infections in Canada. Further investigations into the impact of coronavirus disease 2019 and associated public health measures are underway.