Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2019-2023.

Abstract

Background: Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) continue to contribute to excess morbidity and mortality among Canadians.

Objective: This report describes epidemiologic and laboratory characteristics and trends of HAIs and AMR, 2019-2023, 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, 2019 and December 31, 2023, 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 Candida auris (C. auris). Trend analysis for case counts, incidence rates (rates), outcomes, molecular characterization and AMR profiles are presented.

Results: Rates remained relatively stable for CDI (range: 4.90-5.35 infections per 10,000 patient days) and MRSA BSI (range: 1.00-1.16 infections per 10,000 patient days) and increased significantly for VRE BSIs (range: 0.30-0.37 infections per 10,000 patient days). Infection rates for CPE remained low compared to other HAIs but doubled non-significantly (rates: 0.08-0.16), CPA counts remained very low (n=4 cases) and C. auris isolates remained low (n=36 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. Few 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.