Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS)

Frequently Asked Questions

1. What is the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS)?
CIPARS is a nationally integrated antimicrobial resistance surveillance program developed by the Public Health Agency of Canada (PHAC) in collaboration with federal and provincial partners.  One of the key objectives of CIPARS is to monitor trends in the development of antimicrobial resistance (AMR) in the food chain.  In March 2004, CIPARS released its first report summarizing data collected during 2002 on antimicrobial resistance from human and animal samples. Subsequently, reports have been released on an annual basis.  Beginning with the 2005 data, CIPARS also issues an interim web based report presenting the preliminary data without commentary.

CIPARS has been modelled after international initiatives such as the US National Antimicrobial Resistance Monitoring System (NARMS) and the Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP) to facilitate the comparison of data.

2. What are antimicrobials, antibacterials and antibiotics?
The term antimicrobial includes all substances that can kill or inhibit the growth of microorganisms (eg. antibacterials, antivirals, antimycotics, disinfectants etc.).  Antibacterial refers to both natural and synthetic substances that kill or inhibit growth of bacteria.  Antibiotics should be restricted to natural substances killing or inhibiting the growth of microorganisms.   However, antibiotics and antimicrobials are often used to designate all chemical substances (natural and non-natural) capable of killing off inhibiting bacteria.  Among all antimicrobials, CIPARS currently survey antibacterials.

3. How does resistance develop?
AMR occurs when an antimicrobial substance, or agent, is no longer effective in killing or inhibiting the growth of a particular microorganism.  Cross-resistance or multidrug resistance mechanisms may develop when bacteria exhibiting resistance to one drug, develop resistance to other drugs of the same or different family.  Because of cross-resistance and multidrug resistance mechanisms, the use of one antimicrobial, selecting for resistance in a bacteria to that agent, will possibly select for resistance to other agents at the same time (co-selection).

4. What is cross-resistance?
Antimicrobial resistance is a complex phenomenon caused by a large variety of genetic determinants. Different determinants can encode resistance to the same antimicrobial agent. More importantly, a single determinant can encode resistance to several different antimicrobial agents at the same time. This latter phenomenon called cross-resistance is very frequent for antimicrobial agents belonging to the same antimicrobial class and seems to be the rule rather than the exception.

5. What is multidrug resistance?
Multidrug resistance is another important phenomenon with major practical implications. In this case, multiple unrelated resistance genes end up in the same bacteria making it resistant to several antimicrobial agents of different classes at the same time. A well known case of multidrug resistance is represented by the ACSSuT penta-resistance (ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline) typical of S. Typhimurium PT 104.

6. Why are high levels of antimicrobial resistance important?
Development of resistance stops or reduces the effectiveness of antimicrobial agents intended to treat bacterial infections affecting humans and animals.  AMR threatens our ability to fight these diseases leading to significant economic and public health consequences.  We all have a role to play in preventing AMR (see answer to question #7).

7. Why does CIPARS classify drugs?
Drugs are grouped by level of human health importance following the classification system of the Veterinary Drugs Directorate (VDD) , Health Canada. The rationale for classification used by VDD are: spectrum of activity of antimicrobials, mode of action, mechanism of resistance, availability of alternative antimicrobial therapy, and potential for transfer of resistance. However, this classification does not currently reflect the extent of drug use or the degree to which resistance occurs in human bacterial pathogens. 

8. Why are antimicrobials used in food-producing animals?
Antimicrobials are prescribed and used therapeutically for the treatment of diseases in both humans and animals.  Antimicrobials are also added to the feed of food-producing animals to promote growth, to increase feed efficiency and to prevent infections.

9. Why is CIPARS concentrating its attention on the agri-food sector and is that the major source of AMR?
CIPARS has been developed to provide the scientific data to better understand the relative importance of the agri-food contribution to this complex issue. It is recognized that the use of antimicrobial drugs in the agri-food industry is only one of many contributing factors to the development and spread of resistance among human pathogens.

10. Why does CIPARS only look at cattle, chicken, and swine?
Cattle, chicken and swine represent the food-producing animal groups most commonly consumed in Canada.  However, CIPARS plans to expand its work to include other species.

11. Why does the report include surveillance data results mainly on E. coli and Salmonella?
CIPARS is designed to focus on important foodborne disease-causing agents in humans, such as Salmonella, as well as non-disease agents, such as, generic E. coli that may act as carriers of resistance genes.  CIPARS also does surveillance of Campylobacter in retail chicken and abattoir cattle samples, and Enterococcus in retail chicken and swine on-farm samples.  As CIPARS expands there are plans to broaden the range of bacterial species being monitored.

12. What is the federal government doing to acquire data on the kinds and quantities of antibiotics being used in food animal production in Canada?
Antimicrobials utilized in the food-animal production sector are accessed through a complex web of sales and distribution channels. Since 1999, Health Canada and PHAC have investigated sources and means of acquiring reliable and valid data on antimicrobial use in food-producing animals in Canada.  At the federal level there is no current legislative mechanism to acquire this data.  Much of the legislative power and mandate for this activity rests with the provincial agriculture ministries.  Over-the-counter (OTC) antimicrobial sales (including in-feed use) and the practice of veterinary medicine are regulated by each province. Industry level data were to have been provided in 2005 from a program operated by the Canadian Animal Health Institute (CAHI), but the program has been suspended.  The previously provided preliminary data for 2001-2003 have been withdrawn.  CAHI cites logistical and methodological problems. 

PHAC has worked with academic institutions to acquire antimicrobial use data through the use of on-farm projects.  Projects have been conducted in the dairy, swine, sheep, beef and poultry sectors to collect antimicrobial use data.  Research is also being conducted to develop drug use estimation models in the absence of ongoing data collection. 

The farm component of CIPARS was initiated in 2003 with five-year funding from Agriculture and Agri-Food Canada’s Agriculture Policy Framework.  Swine are being utilized as the initial target species to test the feasibility, and sustainability of an ongoing farm-level surveillance program.  At present, CIPARS On-farm and targeted research projects remain our only source of valid antimicrobial use data from the animal production sectors.

13. Does CIPARS have plans to expand their program?
Planning is underway regarding future work.  For example, expansion is being considered in terms of partnerships, geographic locations, food animal commodities, and the bacterial species being evaluated.

14. What is PHAC doing to address the effects of AMR on humans?
PHAC has been providing ongoing financial support to the Canadian Committee on Antibiotic Resistance since its creation in 1999 to focus efforts on controlling resistance in humans.  Efforts will be made to continue to provide support not only for the animal component of CIPARS but also for the human aspect of the surveillance program.

15. Is Health Canada going to ban growth promoters?
Veterinary Drugs Directorate in Health Canada is responsible for the approval of veterinary antimicrobials in Canada and is supporting surveillance activities to evaluate possible public health impacts of the use of antimicrobial growth promoters. Evidence from the surveillance data is currently being collected and analysed and will be crucial in the development of new policies and approaches.

16. Is food produced from animals treated with antibiotics safe for humans?
Canada’s food system is one of the safest in the world and efforts will continually be made to minimize the development and spread of resistance from agri-food sources.  The findings reported in the CIPARS reports will be very useful in the ongoing risk assessment of antimicrobial drugs.  This is part of a broad initiative aimed at developing comprehensive Canadian policies on antimicrobial resistance and on the use of antimicrobial drugs in food-producing animals. 

17. What can I do to prevent AMR and maintain the usefulness of antibiotics currently available for treatment of human infections?
AMR is recognized as a global public health issue requiring urgent and concerted action by individuals, governments, physicians, veterinarians, farmers, pharmaceutical industries, as well as national and international public health organizations.  You can take some of the following precautions:

• Follow label instructions for the use and disposal of animal medications.
• Farmers are encouraged to improved hygiene on their farms to avoid the need to use antibiotics or other antimicrobial.
• Don't take antibiotics for the treatment of colds, flu and other viral infections.  Be aware that antibiotics are not effective for everything.  For example, 90 percent of colds and flus, and the accompanying coughs, sore throats, aches and pains are caused by viruses. Antibiotics won't help. 
• Take drugs as directed by your doctor or pharmacist.  Don't stop taking a drug part way through the course of treatment or vary the way you take it (eg. taking it twice a day when the label says three times a day), unless you are having a serious adverse reaction, without first discussing it with your doctor.  Always take all of the prescribed antibiotics. Sometimes the infections or symptoms disappear earlier, but the bacteria may not be gone.  The surviving bacteria can recover and will be stronger and more resistant to the antibiotic.
• Don't share your prescriptions with anyone else.  Don't use a prescription for any other purpose other than what it is prescribed for.  Using an inappropriate drug can make the resistance problem worse. 
• Do not flush out-of-date or unused medication down the toilet, pour it down the sink, or put it in the garbage.  Disposing of medication using any one of these methods means that the active ingredients could end up in the water table.  This could increase resistance.  Ask you pharmacist if they have a drug recycling program.  Many pharmacies provide this service so your unused drugs can be disposed of in an environmentally safe manner.
• Avoid use of antibacterial soap and "bacteria-fighting" household cleaning products.  They are proven to be no more effective than regular soap and can lead to antimicrobial resistance.
• Wash your hands regularly with plain soap and water for at least 20 seconds.  It is the most effective way of preventing any type of infection.
• Store, handle and prepare food safely.  When you're preparing food, be sure to wash cutting boards and knives with soap and water.  Thoroughly wash all fruits and vegetables that will be eaten raw.

Refer to the following website for safe food handling practices:
http://www.hc-sc.gc.ca/fn-an/securit/handl-manipul/index_e.html