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Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2020-2024
Insights
Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) saw stable rates for Clostridioides difficile infections (CDI) and MRSA bloodstream infections (BSIs). However, vancomycin-resistant Enterococcus (VRE) BSIs and carbapenemase-producing Enterobacterales (CPE) infections significantly increased in Canadian hospitals.
Area of Science:
- Infectious Diseases
- Public Health
- Microbiology
Background:
- Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose significant threats to patient health in Canada.
- These issues contribute to increased morbidity and mortality, necessitating ongoing surveillance.
Purpose of the Study:
- To analyze the epidemiological and laboratory trends of HAIs and AMR in Canadian acute care hospitals from 2020 to 2024.
- To identify changes in the incidence and characteristics of specific pathogens, including Clostridioides difficile infections (CDI), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs), vancomycin-resistant Enterococcus (VRE) BSIs, carbapenemase-producing Enterobacterales (CPE), carbapenemase-producing Acinetobacter baumannii (CPA), and Candida auris (C. auris).
Main Methods:
- Utilized surveillance and laboratory data from 109 Canadian sentinel acute care hospitals collected between January 1, 2020, and December 31, 2024.
- Monitored key pathogens such as CDI, MRSA BSIs, VRE BSIs, CPE, CPA, and C. auris.
- Conducted trend analysis on case counts, incidence rates, outcomes, and antimicrobial resistance (AMR) profiles.
Main Results:
- Incidence rates for CDI and MRSA BSIs remained stable between 2020 and 2024.
- Significant increases were observed in vancomycin-resistant Enterococcus (VRE) BSIs (from 0.30 to 0.42 per 10,000 patient days; p=0.01) and carbapenemase-producing Enterobacterales (CPE) infections (from 0.05 to 0.20; p=0.03).
- Carbapenemase-producing Acinetobacter baumannii (CPA) and Candida auris (C. auris) counts remained low but showed an increase in C. auris isolates.
Conclusions:
- While MRSA BSIs and CDI incidence remained stable, VRE BSIs and CPE infections have increased in Canadian acute care settings.
- A rise in Candida auris isolates was noted, highlighting the need for continued monitoring.
- Standardized surveillance data is crucial for implementing effective infection prevention and control strategies to mitigate the burden of HAIs and AMR.
Background:
Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) continue to contribute to excess morbidity and mortality among Canadians.
Objective:
To describe epidemiologic and laboratory characteristics and trends of HAIs and AMR, 2020-2024, using surveillance and laboratory data submitted by hospitals to the Canadian Nosocomial Infection Surveillance Program (CNISP) and by provincial and territorial laboratories to the National Microbiology Laboratory.
Methods:
Data was collected from 109 Canadian sentinel acute care hospitals between January 1, 2020 and December 31, 2024 for Clostridioides difficile infections (CDI), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs), vancomycin-resistant Enterococcus (VRE) BSIs (specifically Enterococcus faecalis and Enterococcus faecium), carbapenemase-producing Enterobacterales (CPE) and carbapenemase-producing Acinetobacter baumannii (CPA) infections and colonizations and Candidozyma auris (C. auris; formerly Candida auris) infections. Trend analysis for case counts, incidence rates (rates), outcomes, molecular characterization and AMR profiles are presented.
Results:
From 2020 to 2024, rates remained relatively stable for CDI (range: 5.01-5.38 infections per 10,000 patient days) and MRSA BSI (range: 0.99-1.16 infections per 10,000 patient days) and increased significantly for VRE BSIs (from 0.30 to 0.42 infections per 10,000 patient days; p=0.01). During this time, infection rates for CPE remained low compared to other HAIs but increased significantly (rates: 0.05-0.20; p=0.03), CPA counts continue to remain very low (n=22 infections) and C. auris counts remained low compared to other HAIs (n=43 isolates).
Conclusion:
The incidence of MRSA BSIs and CDI remained stable and VRE BSIs and CPE infections increased in the Canadian acute care hospitals participating in CNISP. An increased number of C. auris isolates were identified. Reporting standardized surveillance data to inform the application of infection prevention and control practices in acute care hospitals is critical to help decrease the burden of HAIs and AMR in Canada.
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