Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS)

For more information please email cipars-picra@hc-sc.gc.ca

Preamble

We are posting preliminary¹ antimicrobial resistance (AMR) findings for the most recent complete calendar year 2007 on the CIPARS website. New in this 3^rd edition of the ‘Preliminary Results’ is the addition of AMR temporal variation figures (from 2003 to 2007) and of MIC tables. Data from the following program components are available in this report:

• Surveillance of Human Clinical Isolates
• Abattoir Surveillance
• Retail Meat Surveillance
• Surveillance of Animal Clinical Isolates

Integrated analysis results based on human and agri-food AMR data will be presented in the full 2007 CIPARS Annual Report, as well as On-Farm Surveillance AMR and antimicrobial use results from pigs, human antimicrobial consumption estimates in the Canadian community (Canadian CompuScript- IMS Health) and kilograms of antimicrobials distributed in Canada in animals (Canadian Animal Health Institute).

---

¹ 2007 Data were extracted from dataset as of February 27th and March 13th 2008 for the the human and the agri-food isolates respectively.

What is New in the 2007 'Preliminary Results'

Antimicrobials Categorization

• No changes have been made to the Veterinary Drug Directorate antimicrobial categorization since November 30, 2006 (For more details see the website http://www.hc-sc.gc.ca/dhpmps/ consultation/vet/consultations/amr_ram_hum-med_e.html). This categorization (from I to IV) is based on the importance of antimicrobials in human medicine. All figures and tables representing individual AMR prevalence results are based on this categorization.

New data

• The province of British Columbia was added to the Retail Meat Surveillance component. Please note that in this province, retail meat samples have not been collected over a full year of sampling.
• Results from equine clinical isolates were added to the Surveillance of Animal Clinical Isolates section because of the level of antimicrobial resistance and the number of Salmonella that were received for that species in 2007.

Laboratory method changes

• Enterococcus plate: bacitracin (Category III) was removed, and tigecycline (Category I) added.
• In an effort to harmonise CIPARS results interpretation with the National Antimicrobial Resistance Monitoring System, new Enterococcus resistance breakpoints were adopted in 2007 for lincomycin (from ≥32 to ≥8 ug/ml), kanamycin (from ≥256 to ≥1024 ug/ml), and streptomycin (from >1000 to ≥1000 ug/ml). These changes had little or no impact on the proportion of resistant isolates, except for lincomycin where this change resulted in an increase of 15 to 20% of the resistance.
• In 2007, a new Salmonella recovery method was adopted for the Retail Meat Surveillance component which resulted in an important increase in recovery. Details regarding the impact of this change are presented in the full 2006 CIPARS Annual Report. A description of this new recovery method will be presented in the Methods section of the full 2007 Annual report.
• For further information on our methodology, please consult the most recent CIPARS Annual Report at: http://www.phac-aspc.gc.ca/cipars-picra/index.html.

CIPARS Surveillance Components

Surveillance of Human Clinical Isolates

The Surveillance of Human Clinical Isolates component is designed to provide representative data on Salmonella isolates at the provincial level. All human Salmonella isolates received by the provincial public health laboratories in New Brunswick, Newfoundland, Nova Scotia, Manitoba, Prince Edward Island, and Saskatchewan are forwarded to the National Microbiology Laboratory of the Public Health Agency of Canada in Winnipeg, Manitoba. More populated provinces (Alberta, British Columbia, Ontario, and Québec) forward isolates received from the first to the 15^th of each month. In addition, in 2007, all human isolates of S. Newport and S. Typhi were forwarded to the National Microbiology Laboratory because of concerns of emerging multidrug resistance and clinical importance respectively. Once we produced this document, only a subset of Salmonella isolates had been tested. The full annual report should include all isolates received in 2007.

Note: In Canada, while there are legislative requirements to report all new cases of salmonellosis to local and provincial public health authorities, forwarding of isolates from these cases by local laboratories is voluntary. When interpreting CIPARS data, it should be noted that most but not all isolates from reported cases are sent to provincial public health laboratories for reference testing. The total number of Salmonella isolates by serovar must be considered when interpreting the proportion of resistant isolates. Other limitations of surveillance data include disease under-diagnosing and under-reporting, which can lead to underestimating the true incidence of salmonellosis cases.

Abattoir Surveillance (chickens, swine, and beef cattle)

The Abattoir Surveillance component is designed to provide nationally representative antimicrobial resistance data from bacteria isolated from animals entering the food chain. Caecal contents (not carcass) from slaughtered food-producing animals are sampled to avoid misinterpretation related to crosscontamination and to better reflect the antimicrobial resistance at the farm level. All samples are shipped to the PHAC Laboratory for Foodborne Zoonoses (Saint-Hyacinthe) for microbiological analyses.

This program was initiated in September 2002 with sampling designed to target Escherichia coli and Salmonella from beef cattle, swine, and broiler chicken. Salmonella recovery from beef cattle was interrupted in 2003 due to low prevalence in this commodity. Program refinement in September 2005 included the addition of Campylobacter isolation from beef cattle.

Over 90% of all food-producing animals in Canada are slaughtered in federally inspected abattoirs. Forty-six federally inspected slaughter plants (24 poultry plants, 13 swine plants, and 9 beef cattle plants) from across Canada participated in the 2007 CIPARS abattoir component. The “beef cattle” dataset may include a small number of samples from dairy cattle, as a small number of plants slaughter both commodities, however veal is excluded.

Our collection periods are uniformly distributed over a 12-month course to avoid any potential seasonal bias in bacteria prevalence and antimicrobial susceptibility. Our sampling program is designed to yield approximately 150 isolates per targeted bacterial and animal species per year across Canada.

Retail Meat Surveillance (chicken, pork, and beef)

The objective of our Retail Meat Surveillance component is to examine antimicrobial resistance of select bacteria found in raw meat at the retail level. Retail sampling provides a measure of human exposure to antimicrobial resistant bacteria via undercooked meat consumption or cross-contamination with raw food products. In 2007, we collected samples in British Columbia, Saskatchewan, Ontario, and Québec.

We are interested in bacterial isolates cultured from specific meat products commonly consumed by Canadians such as poultry (chicken legs or wings), pork (chops), and beef (ground beef). These meat selection mirrors the animal productions studied in the Abattoir Surveillance component of our program. For ground beef, we systematically select samples from extra lean, lean, medium and regular ground beef to reflect the heterogeneity of this product in terms of the commodity combinations of fed beef and cull dairy, and the domestic vs. imported meat content.

The bacteria of interest in poultry are Campylobacter, Salmonella, Enterococcus, and E. coli. In pork and beef we only perform antimicrobial resistance test on E. coli², since there is a low prevalence of Campylobacter and Salmonella (less than three percent each) at retail in these commodities, as determined during the early phase of the program.

The sampling protocol involves continuous weekly sample submissions from randomly selected census divisions, weighted by population, in each of the selected provinces. Using prevalence estimates from the previous year, our sampling protocols are designed to yield approximately 100 isolates per commodity per province per year, plus 20% for lost or damaged samples.

Note: We did not collect 100 Salmonella isolates for retail chicken in 2007 in the provinces of British Columbia and Saskatchewan as resources to expand our sampling capacity were not available at this point in time, and sampling did not occur through the year in British Columbia.

---

² We perform Salmonella recovery tests from retail pork to obtain a prevalence estimate of contamination, but due to the small number of isolates recovered annually, we do not report AMR in Salmonella isolated from pork.

Surveillance of Animal Clinical Isolates (chickens, swine, bovine, turkeys, and equine)

The Surveillance of Animal Clinical Salmonella Isolates component originates primarily from veterinary diagnostic submissions collected by veterinarians and/or producers. These isolates are sent by provincial animal health laboratories across the country to the Salmonella Typing Laboratory at the Laboratory for Foodborne Zoonoses (Guelph, Ontario), where they are serotyped, susceptibility tested, and in some cases, phagetyped. Isolates from Québec are serotyped by the Laboratoire d’épidémiosurveillance animale du Québec before being shipped to the Salmonella Typing Laboratory of Guelph where they are phagetyped when appropriate, and tested for AMR.

Note: The number of submissions varies considerably between provinces. Unlike our Surveillance of Human Clinical Isolates program, all isolates received by provincial animal health laboratories may not necessarily be forwarded to the Laboratory for Foodborne Zoonoses of Guelph, with the exception of the provinces of Ontario and Québec. Most samples are obtained from diseased animals and sample submissions may have followed therapeutic failure. Generally, these animals do not enter the food chain. Despite the fact that contamination through direct contact with a diseased animal is possible, we assume that this risk is lower at the national level than exposure through contaminated food. For these reasons, estimates from these animal isolates are judged not appropriate for evaluating general human exposure to antimicrobial resistance. Information from these animal isolates is however valuable for detecting emerging resistance, identifying new multidrug resistance patterns, and assessing the occurrence of resistance in sick animals.

Table of Contents

• Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) 2007
• Preamble
  • What is New in the 2007 'Preliminary Results'
  • CIPARS Surveillance Components
• List of Figures
• List of Tables
• Humans
  • Salmonella
• Agri-Food Sector
  • Chickens
    • Salmonella
    • Escherichia coli
    • Campylobacter
    • Enterococcus
  • Swine
    • Salmonella
    • Escherichia coli
  • Bovine
    • Salmonella
    • Escherichia coli
    • Campylobacter
  • Turkeys
    • Salmonella
  • Equine
    • Salmonella
• Appendix
  • MIC Tables - Humans
  • MIC Tables - Agri-Food Sector
  • Recovery Table