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Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016

Antimicrobial Resistance and Infection Control. 2020;9(1):1-10 DOI 10.1186/s13756-020-0684-2


Journal Homepage

Journal Title: Antimicrobial Resistance and Infection Control

ISSN: 2047-2994 (Online)

Publisher: BMC

LCC Subject Category: Medicine: Internal medicine: Infectious and parasitic diseases

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML



Wallis Rudnick (Public Health Agency of Canada)

Michelle Science (SickKids)

Daniel J. G. Thirion (Université de Montréal)

Kahina Abdesselam (Public Health Agency of Canada)

Kelly B. Choi (Public Health Agency of Canada)

Linda Pelude (Public Health Agency of Canada)

Kanchana Amaratunga (Public Health Agency of Canada)

Jeannette L. Comeau (IWK Health Centre)

Bruce Dalton (Alberta Health Services)

Johan Delport (London Health Sciences Centre)

Rita Dhami (London Health Sciences Centre)

Joanne Embree (University of Manitoba)

Yannick Émond (Hôpital Maisonneuve-Rosemont)

Gerald Evans (Kingston General Hospital)

Charles Frenette (McGill University Health Centre)

Susan Fryters (Alberta Health Services)

Greg German (Health PEI)

Jennifer M. Grant (University of British Columbia)

Jennifer Happe (Infection Prevention and Control Canada)

Kevin Katz (North York General Hospital)

Pamela Kibsey (Royal Jubilee Hospital)

Justin Kosar (Saskatchewan Health Authority)

Joanne M. Langley (IWK Health Centre)

Bonita E. Lee (Stollery Children’s Hospital)

Marie-Astrid Lefebvre (McGill University Health Centre)

Jerome A. Leis (Sunnybrook Research Institute)

Allison McGeer (Sinai Health System)

Heather L. Neville (Nova Scotia Health Authority)

Andrew Simor (University of Toronto)

Kathryn Slayter (IWK Health Centre)

Kathryn N. Suh (The Ottawa Hospital)

Alena Tse-Chang (Stollery Children’s Hospital)

Karl Weiss (SMBD-Jewish General Hospital)

John Conly (Alberta Health Services)

the Canadian Nosocomial Infection Surveillance Program


Blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 13 weeks


Abstract | Full Text

Abstract Background Antimicrobial resistance is a growing threat to the world’s ability to prevent and treat infections. Links between quantitative antibiotic use and the emergence of bacterial resistance are well documented. This study presents benchmark antimicrobial use (AMU) rates for inpatient adult populations in acute-care hospitals across Canada. Methods In this retrospective surveillance study, acute-care adult hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) submitted annual AMU data on all systemic antimicrobials from 2009 to 2016. Information specific to intensive care units (ICUs) and non-ICU wards were available for 2014–2016. Data were analyzed using defined daily doses (DDD) per 1000 patient days (DDD/1000pd). Results Between 2009 and 2016, 16–18 CNISP adult hospitals participated each year and provided their AMU data (22 hospitals participated in ≥1 year of surveillance; 11 in all years). From 2009 to 2016, there was a significant reduction in use (12%) (from 654 to 573 DDD/1000pd, p = 0.03). Fluoroquinolones accounted for the majority of this decrease (47% reduction in combined oral and intravenous use, from 129 to 68 DDD/1000pd, p < 0.002). The top five antimicrobials used in 2016 were cefazolin (78 DDD/1000pd), piperacillin-tazobactam (53 DDD/1000pd), ceftriaxone (49 DDD/1000pd), vancomycin (combined oral and intravenous use was 44 DDD/1000pd; 7% of vancomycin use was oral), and ciprofloxacin (combined oral and intravenous use: 42 DDD/1000pd). Among the top 10 antimicrobials used in 2016, ciprofloxacin and metronidazole use decreased significantly between 2009 and 2016 by 46% (p = 0.002) and 26% (p = 0.002) respectively. Ceftriaxone (85% increase, p = 0.0008) and oral amoxicillin-clavulanate (140% increase, p < 0.0001) use increased significantly but contributed only a small component (8.6 and 5.0%, respectively) of overall use. Conclusions This study represents the largest collection of dispensed antimicrobial use data among inpatients in Canada to date. Between 2009 and 2016, there was a significant 12% decrease in AMU, driven primarily by a 47% decrease in fluoroquinolone use. Modest absolute increases in parenteral ceftriaxone and oral amoxicillin-clavulanate use were noted but contributed a small amount of total AMU. Ongoing national surveillance is crucial for establishing benchmarks and antimicrobial stewardship guidelines.