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To investigate the acquisition and relatedness of New Delhi Metallo-beta-lactamase among multiple separate species from one patient. Five isolates from three species (Pseudomonas aeruginosa; Pa, Acinetobacter baumannii; Ab and Proteus mirabilis; Pm) suspected of harbouring a carbapenemase were investigated by phenotype (antimicrobial susceptibilities) and whole genome sequencing. Epidemiological data was collected on this patient. Three different carbapenemase genes were detected; blaVIM-1 (Pa; ST773), blaOXA-23 (Ab, ST499) and blaNDM-1 identified in all isolates. NDM regions were found chromosomally integrated in all isolates. Data showed no evidence of NDM-1 transfer within this patient suggesting the enzyme was acquired in three separate events. [ABSTRACT FROM AUTHOR]

Background: Neisseria gonorrhoeae have acquired resistance to many antimicrobials, including third generation cephalosporins and azithromycin, which are the current gonococcal combination therapy recommended by the Canadian Guidelines on Sexually Transmitted Infections.Objective: To describe antimicrobial susceptibilities for N. gonorrhoeae circulating in Canada between 2012 and 2016.Methods: Antimicrobial resistance profiles were determined using agar dilution of N. gonorrhoeae isolated in Canada 2012-2016 (n=10,167) following Clinical Laboratory Standards Institute guidelines. Data were analyzed by applying multidrug-resistant gonococci (MDR-GC) and extensively drug-resistant gonococci (XDR-GC) definitions.Results: Between 2012 and 2016, the proportion of MDR-GC increased from 6.2% to 8.9% and a total of 19 cases of XDR-GC were identified in Canada (0.1%, 19/18,768). The proportion of isolates with decreased susceptibility to cephalosporins declined between 2012 and 2016 from 5.9% to 2.0% while azithromycin resistance increased from 0.8% to 7.2% in the same period.Conclusion: While XDR-GC are currently rare in Canada, MDR-GC have increased over the last five years. Azithromycin resistance in N. gonorrhoeae is established and spreading in Canada, exceeding the 5% level at which the World Health Organization states an antimicrobial should be reviewed as an appropriate treatment. Continued surveillance of antimicrobial susceptibilities of N. gonorrhoeae is necessary to inform treatment guidelines and mitigate the impact of resistant gonorrhea. [ABSTRACT FROM AUTHOR]

The goal of this document was to provide Canadian laboratories with a framework for consistent reporting and monitoring of multidrug resistant organisms (MDRO) and extensively drug resistant organisms (XDRO) for common gram-negative pathogens. This is the final edition of the interim recommendations, which were modified after one year of broad consultative review. This edition represents a consensus of peer-reviewed information and was co-authored by the Canadian Public Health Laboratory Network and the Canadian Association of Clinical Microbiology and Infectious Diseases. There are two main recommendations. The first recommendation provides standardized definitions for MDRO and XDRO for gram-negative organisms in clinical specimens. These definitions were limited to antibiotics that are commonly tested clinically and, to reduce ambiguity, resistance (rather than non-susceptibility) was used to calculate drug resistance status. The second recommendation identifies the use of standardized laboratory reporting of organisms identified as MDRO or XDRO. Through the broad consultation, which included public health and infection prevention and control colleagues, these definitions are ready to be applied for policy development. Both authoring organizations intend to review these recommendations regularly as antibiotic resistance testing evolves in Canada. [ABSTRACT FROM AUTHOR]

The article presents recommendations for the reporting of extensively drug resistant and pan-drug resistant isolates of Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter spp. and Stenotrophomonas maltophilia. The recommendations provide Canadian laboratories with a framework for consistent reporting and monitoring of multi-drug resistant organisms (MDRO), extensively drug resistant organisms (XDRO), and pan-drug resistant organisms (PDRO).

Introduction Methicillin-resistant Staphylococcus aureus (MRSA) infections and colonization have increased among Canadian children in both the community and hospital setting. Although strategies to prevent and limit spread of MRSA in the hospital setting are recommended, they can be challenging to implement in the course of providing specialized care to hospitalized infants, children, youth and their families. The purpose of this Canadian Nosocomial Infection Surveillance program (CNISP) survey was to determine existing infection control practices in Canadian pediatric healthcare settings. Methods Hospitals providing care to children in 2010 were eligible to participate in this cross-sectional survey, as was posted on the Canadian and province of Quebec infection prevention and control professional association websites with widespread invitations to encourage participation. Survey items were generated by the Pediatric MRSA Working Croup of the CNISP Data were extracted, cleaned and analyzed using Microsoft Excel (2007/2010) and additional analyses conducted using Epicalc 2000 Version 1.02, at the Public Health Agency of Canada. Results Fifty hospitals responded; 88% were acute care and 96% conducted inpatient admission screening. Of the 96% of hospitals conducting MRSA screening, 88% screened children if they had a history of any prior hospital admission, 76% if the child was known to be MRSA-positive, and 88% if the child had a history of contact with MRSA. All hospitals applied Additional Precautions (AP) to confirmed MRSA positive patients and 46% applied AP to screened patients while awaiting screening results. Implementation of the use of gowns, gloves, masks and/or eye protection varied across hospitals and patient care areas. Twenty-two percent reported routinely decolonizing MRSA patients in specific circumstances, and 46% had a policy regarding decolonization. Although most hospitals flagged health records of MRSA positive patients, criteria to remove a flag from the health record varied. Conclusions Although policies and procedures to prevent MRSA transmission in the health care setting are routine in Canadian pediatric settings, there is variation in application of national guidelines. Evidence-based guidelines specific to the care of infants, children and youth would help improve consistency across care settings, and understanding and compliance with infection prevention and control policy by health care providers, patients and families. [ABSTRACT FROM AUTHOR]

Background: Gonorrhea is on the rise in Canada. Treatment has been complicated by the fact that Neisseria gonorrhoeae has acquired resistance to many antibiotics, including penicillin, tetracycline, erythromycin and ciprofloxacin. The emergence of isolates with decreased susceptibilities to the third generation cephalosporins and reports of treatment failures in Canada and around the world are cause for concern.Objective: To assess the resistance levels of common antibiotics to N. gonorrhoeae and to observe trends in resistance and/or decreased susceptibility to ciprofloxacin, third generation cephalosporins and azithromycin.Methods: Laboratory surveillance data for N. gonorrhoeae isolates submitted by provincial microbiology laboratories to the National Microbiology Laboratory (NML) from 2009-2013 were compared.Results: Since 2009, there has been an overall rise in antibiotic-resistant N. gonorrhoeae. In 2013, 24.3% of the isolates were resistant to erythromycin, 18.9% were resistant to penicillin, 33.0% were resistant to tetracycline, and 29.3% were resistant to ciprofloxacin. The percentage of isolates with decreased susceptibility to ceftriaxone (≥0.125 mg/L) and/or cefixime (≥0.25 mg/L) was 3.9% in 2013. This number represents a decrease from 5.9% in 2012 and 7.6% in 2011. The proportion of azithromycin resistant (MIC ≥2 mg/L) N. gonorrhoeae isolates increased from 0.4% in 2009 to 1.2% in 2013.Conclusion: Resistance to erythromycin, penicillin, tetracycline and ciprofloxacin is common. Decreased susceptibility to ceftriaxone and/or cefixime is now almost 4% and azithromycin resistance is emerging but remains low at 1.2%. These results have informed the gonococcal infection treatment recommendations in the Canadian Guidelines on Sexually Transmitted Infections. [ABSTRACT FROM AUTHOR]