On December 21, 2021, a network of Canadian hospitals published a paper in CMAJ Open, reporting on their Global-PPS results. This study describes antimicrobial use (AMU) based on detailed patient-level data in Canadian hospitals in 2018 in terms of antimicrobial prevalence, indications and agent selection in adult and paediatric medical, surgical and intensive care wards. In addition, it evaluates the quality of antimicrobial prescribing using a set of key quality indicators.

A Pan-Canadian strategy

In 2017, Canada released Tackling Antimicrobial Resistance and Antimicrobial Use: A Pan-Canadian Framework for Action to reinforce its strategy on antimicrobial resistance. Surveillance of AMU is a core component of Canada’s framework for action and that is why Global-PPS was used to obtain this data.

What were the results?

In this study, 47 hospitals participated with 13,272 patients. A total of 6,525 prescriptions were reviewed. The overall AMU prevalence was 33.5% :  74.1% were used for therapeutic purpose, 12.6% for medical prophylaxis and 8.9% for surgical prophylaxis. Out of all therapeutic  prescriptions, 61% were used empirically and 39% were targeted. The most frequent diagnostic categories of use were for respiratory tract infections (29.6%), urinary tract infections (11.6%) and intra-abdominal infections (11%).  Thirty-eight percent were used for nosocomial infections.  Targeted treatment for documented MDRO was relatively infrequent as only 82 patients had documented MRSA infection, 101 with resistance to 3^rd generation cephalosporin Enterobacteriaceae and 30 with carbapenem resistance ( 5 carbapenemase producing).  The diagnosis was documented in the patient’s file at the initiation for 87.3% of antimicrobials. In addition, the study showed that 62.9% of antimicrobials had a stop or review date and 72.0% of prescriptions were guided by local guidelines.

Conclusion

This is the largest surveillance project on antimicrobial use and resistance in Canada. The study provides valid and reliable information on antimicrobial prescribing practices, and identified areas of improvement in participating Canadian hospitals. The overall use of antimicrobials is similar to what was previously reported in Canada, and confirms that treatment for MDRO is low. (C. Frenette et al., Antimicrob Resist Infect Control, 2020). Two findings suggest that antimicrobial prescribing is becoming more rational:

• The prevalence of AMU in pediatric and neonatal patients seems to be decreasing
• Surgical prophylaxis with one dose was prioritized over surgical prophylaxis for more than a day. Adherence to surgical prophylaxis guidelines was high amongst the surveyed hospitals, although it was lower in the Atlantic Provinces. New protocols have since been developed in this region.

The results serve as a broad-based benchmark for national and local stewardship programs. Through repeated surveys, the Global-PPS will also enable us to continue to measure the impact of interventions.

 Read the article here : G. German, C. Frenette, et al., CMAJ Open, 2021