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Background: Insufficient data on the rate and distribution of SARS-CoV-2 infection in Canada has presented a substantial challenge to the public health response to the COVID-19 pandemic. Our objective was to assess SARS-CoV-2 seroprevalence in a representative sample of pregnant people throughout Canada, across multiple time points over 2 years of the pandemic, to describe the seroprevalence and show the ability of this process to provide prevalence estimates., Methods: This Canadian retrospective serological surveillance study used existing serological prenatal samples across 10 provinces over multiple time periods: Feb. 3-21, 2020; Aug. 24-Sept. 11, 2020; Nov. 16-Dec. 4, 2020; Nov. 15-Dec. 3, 2021; and results from the province of British Columbia during a period in which the SARS-CoV-2 B.1.1.529 (Omicron) variant was predominant, from Nov. 15, 2021, to June 11, 2022. Age and postal code administrative data allowed for comparison with concurrent polymerase chain reactivity (PCR)-positive results collected by Statistics Canada and the Canadian Surveillance of COVID-19 in Pregnancy (CANCOVID-Preg) project., Results: Seropositivity in antenatal serum as early as February 2020 indicates SARS-CoV-2 transmission before the World Health Organization's declaration of the pandemic. Seroprevalence in our sample of pregnant people was 1.84 to 8.90 times higher than the recorded concurrent PCR-positive prevalence recorded among females aged 20-49 years in November-December 2020. Overall seropositivity in our sample of pregnant people was low at the end of 2020, increasing to 15% in 1 province by the end of 2021. Seroprevalence among pregnant people in BC during the Omicron period increased from 5.8% to 43% from November 2021 to June 2022., Interpretation: These results indicate widespread vulnerability to SARS-CoV-2 infection before vaccine availability in Canada. During the time periods sampled, public health tracking systems were under-reporting infections, and seroprevalence results during the Omicron period indicate extensive community spread of SARS-CoV-2 infection., Competing Interests: Competing interests: Lori Beach reports receiving funding from the Public Health Agency of Canada (PHAC) and from the Canadian Diagnostic Executive Forum, Toronto, for support for travel to speak at a meeting. Dr. Beach is also division head of Public Outreach and Communications for the Canadian Society of Clinical Chemists. Shelly Bolotin reports receiving support for the present manuscript from COVID-19 Immunity Task Force and Public Health Ontario. Dr. Bolotin is co-investigator on several COVID-19 grants funded by the Canadian Institutes of Health Research (CIHR), the Canadian Immunity Taskforce, the Canadian Immunization Research Network and PHAC. Dr. Bolotin is associate professor at the University of Toronto and, as part of that role, is director of the centre for Vaccine Preventable Diseases at the university. The centre is supported by the Dalla Lana School of Public Health (DLSPH), which receives funding from government, philanthropic, not-for-profit and private-sector organizations. Private-sector funding sources include vaccine manufacturers, specifically Merck, Sanofi and Pfizer. A set of governance processes are in place at the DLSPH to ensure independent operation of the centre. Isabelle Boucoiran reports receiving grants or contracts from Altona, the National Institutes of Health, CIHR and the Québec Ministère de la Santé et des Services Sociaux, and consulting fees from Pfizer. Dr. Boucoiran has also received equipment, materials, drugs, medical writing, gifts or other services from Altona. Mel Krajden reports receiving reagent support from Siemens to assess SARS-CoV-2 serology and had a contract with Hologic to support respiratory virus testing. Vanessa Poliquin reports receiving grants or contracts from GSK as the site principal investigator for a respiratory syncytial virus vaccine study. Dr. Poloquin has received an honorarium from Sanofi Pasteur for teaching at a continuing medical education event and payment for expert testimony from the Department of Justice Canada. George Zahariadis reports receiving support for the current manuscript from the Public Health Agency of Canada, as well as grants or contracts from Genome Atlantic and CIHR. Dr. Zahariadis also reports receiving unrestricted educational funding from Roche and Abbott to the Eastern Health Regional Health Authority to attend virtual meetings and in specific restricted circumstances, travel to educational, technical and research meetings. Dr. Zahariadis is the past president of the National Molecular Users Group. Jason Robinson reports receiving a Roche Ideas Grant including in-kind reagents for previous work on salivary antibody detection. Vanessa Tran reports receiving grants from CIHR, the COVID-19 Immunity Task Force, Canadian Immunization Research Network and PHAC, outside the submitted work. Dr. Tran is also a member of Canadian Immunization Research Network Management Committee and the COVID-19 Immunity Task Force Leadership Group. Deborah Money reports receiving support for the present manuscript from PHAC, paid to the institution on behalf of the COVID-19 Immunity Task Force. Dr. Money has also received past funding for unrelated work from Merck, GSK, Sanofi and Novartis, paid to the institution. No other competing interests were declared., (© 2023 CMA Impact Inc. or its licensors.)

Background: Patient-level surveillance of antimicrobial use (AMU) in Canadian hospitals empowers the reduction of inappropriate AMU and was piloted in 2017 among 14 hospitals in Canada. We aimed to describe AMU on the basis of patient-level data in Canadian hospitals in 2018 in terms of antimicrobial prescribing prevalence and proportions, antimicrobial indications, and agent selection in medical, surgical and intensive care wards., Methods: Canadian adult, pediatric and neonatal hospitals were invited to participate in the standardized web-based cross-sectional Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) conducted in 2018. An identified site administrator assigned all wards admitting inpatients to specific surveyors. A physician, pharmacist or nurse with infectious disease training performed the survey. The primary outcomes were point prevalence rates for AMU over the study period regarding prescriptions, indications and agent selection in medical, surgical and intensive care wards. The secondary outcomes were AMU for resistant organisms and practice appropriateness evaluated on the basis of quality indicators. Antimicrobial consumption is presented in terms of prevalence and proportions., Results: Forty-seven of 118 (39.8%) hospitals participated in the survey; 9 hospitals were primary care centres, 15 were secondary care centres and 23 were tertiary or specialized care centres. Of 13 272 patients included, 33.5% ( n = 4447) received a total of 6525 antimicrobials. Overall, 74.1% (4832/6525) of antimicrobials were for therapeutic use, 12.6% ( n = 825) were for medical prophylaxis, 8.9% ( n = 578) were for surgical prophylaxis, 2.2% ( n = 143) were for other use and 2.3% ( n = 147) were for unidentified reasons. A diagnosis or indication was documented in the patient's file at the initiation for 87.3% ( n = 5699) of antimicrobials; 62.9% ( n = 4106) of antimicrobials had a stop or review date; and 72.0% ( n = 4697) of prescriptions were guided by local guidelines., Interpretation: Overall, three-quarters of AMU was for therapeutic use across participating hospitals. Canadian hospitals should be further incentivized to create and adapt local guidelines on the basis of recent antimicrobial resistance data., Competing Interests: Competing interests: Daniel Thirion has shares in Lumed. No other competing interests were declared., (© 2021 CMA Joule Inc. or its licensors.)