Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS)

Integrated Analysis and Reporting

• Changes to CIPARS 

Data Management and Analysis

CIPARS is designed to generate antimicrobial resistance information from farm to fork, as well as from human and animal clinical cases.  Over the past years, CIPARS, together with the Information Management / Information Technology Directorate, has established the Antimicrobial Resistance Surveillance System (AMRSS) which serves as a central data repository.  Since the end of 2006, certified data from the 3 local PHAC laboratories migrate on a daily basis into a live central data repository, where they are integrated and standardized.  Records are further cleaned, transformed and interpreted to allow the determination of antimicrobial resistance status.  These manipulations occur through DEXA, a data extraction application maintained by the Data Coordination Program of the Office of Public Health Practice.  Specific CIPARS reports have also been added to DEXA and allow a more timely flow of the antimicrobial resistance information to specific end-users.

CIPARS antimicrobial resistance data are interpreted using the most current breakpoints from the Clinical Laboratory Standard Institute (CLSI).  When no CLSI interpretative criteria are available, CIPARS uses epidemiological breakpoints defined from MIC distribution.  To allow accurate international comparisons, all breakpoints are harmonised with the U.S. National Antimicrobial Resistance Monitoring System (NARMS).

Table 1. Salmonella and E. coli breakpoints in 2006 (CMV1AGNF plate)

Antimicrobial1	Range tested in 2006 μg/ml	Breakpoints 2 μg/ml
		S	I	R
amikacin	0.5-32	≤ 16	32	≥ 64
amoxicillin-clavulinic acid	1.0/0.5 -  32/16	≤ 8/4	16/8	≥ 32/16
ampicillin	1-32	≤ 8	16	≥ 32
cefoxitin	0.5-32	≤ 8	16	≥ 32
ceftiofur	0.25-8	≤ 2	4	≥ 8
ceftriaxone	0.25-64	≤ 8	16-32	≥ 64
chloramphenicol	2-32	≤ 8	16	≥ 32
ciprofloxacin	0.0156-4	≤ 1	2	≥ 4
gentamicin	0.25-16	≤ 4	8	≥ 16
kanamycin	8-64	≤ 16	32	≥ 64
nalidixic acid	0.5-32	≤ 16	-	≥ 32
streptomycin3	32-64	≤ 32	-	≥ 64
sulfisoxazole	16-512	≤ 256	-	≥ 512
tetracycline	4-32	≤ 4	8	≥ 16
trimethoprim-sulfamethoxazole	0.12/2.38-4/76	≤ 2/38	-	≥ 4/76
1  CMV1AGNF plate 2 CLSI M100-S16 Table 2A. M7-A6-MIC Testing section. 3 No CLSI Enterobacteriaceae interpretive criteria available for this antimicrobial. Breakpoint based on MIC distribution and harmonized with NARMS.

Table 2. Campylobacter breakpoints in 2006 (CAMPY plate)

Antimicrobial	Range tested in 2005 ug/ml	Breakpoints1 ug/ml
		S	I	R
azithromycin 2	0.015-64	≤ 2		≥ 8
ciprofloxacin	0.015-64	≤ 1	2
clindamycin 2	0.03-16	≤ 2	4	≥ 8
erythromycin	0.03-64	≤ 8	16	≥ 32
florfenicol 2	0.03-64	≤ 4	NA3	NA
gentamicin 2	0.12-32	≤ 2	4	≥ 8
nalidixic acid 2	4-64	≤ 16	32	≥ 64
telithromycin	0.015-8	≤ 4	8	≥ 16
tetracycline	0.06-64	≤ 4	8	≥ 16
1 CLSI M45 2 No CLSI Campylobacter interpretive criteria available for this antimicrobial. Breakpoint based on MIC distribution and harmonized with NARMS. 3 No resistant breakpoint defined dot this point.

Table 3. Enterococcus breakpoints in 2006 (CMV2AGPF plate)

Antimicrobial	Range tested in 2006 ug/ml	Breakpoints1 ug/ml
		S	I	R
chloramphenicol	2 - 32	≤ 8	16	≥ 32
ciprofloxacin	0.12 - 4	≤ 1	2	≥ 4
daptomycin 2 (cyclic lipopeptide)	0.5 -16	≤ 4
erythromycin	0.5 - 8	≤ 0.5	1 - 4	≥ 8
flavomycin 2	1 -16	<8	16	≥ 32
gentamicin (high-level)	128 - 1024	<500		≥ 500
kanamycin 1(high-level) 2	128 - 1024	<128		≥ 256
lincomycin 2	1 - 32	<8	16	≥ 32
linezolid (oxazolidinones)	0.5 - 8	≤ 2	4	≥ 8
nitrofurantoin	2 - 64	≤ 32	64	≥ 128
penicillin	0.5 -16	≤ 8	-	≥ 16
quinupristin-dalfopristin (streptogramins)	1-32	≤ 1	2	≥ 4
streptomycin (high-level) 2	512-2048	< 512		≥ 1000
tetracycline	4-32	≤ 4	8	≥ 16
tigecycline	0.015 - 0.5	≤ 0.25	0.5	≥1
tylosin 2	0.25 - 32	< 4	16	≥ 32
vancomycin	0.5 - 32	≤ 4	8 -16	≥ 32
1 CLSI M100-S16 Table 2D. M7-A6-MIC Testing section. 2 No CLSI Enterococcus interpretive criteria available for this antimicrobial. Breakpoint based on MIC distribution and harmonized with NARMS.