Alarming Rise in Drug-Resistant Infections Reported Across Canadian Hospitals
A new study reveals a concerning exponential increase in carbapenemase-producing Enterobacterales (CPE) infections and colonization within Canadian acute-care hospitals, signaling a potential crisis in infection control. The findings, published last week in Antimicrobial Resistance and Infection Control, underscore the urgent need for enhanced preventative measures.
Researchers with the Public Health Agency of Canada analyzed data from the Canadian Nosocomial Infection Surveillance Program (CNISP) spanning 2010 through 2023. This analysis included CPE isolates submitted by participating hospitals, alongside detailed patient and microbiological data. While a previous assessment of CNISP data from 2010 to 2014 showed no significant increase in CPE incidence, recent trends indicate a rapidly evolving threat.
In 2023 alone, 97 hospitals reported a total of 138 CPE infections, translating to an incidence rate of 0.14 per 10,000 patient-days. This represents a substantial increase from the 0.03 per 10,000 patient-days recorded in 2010. Perhaps even more alarming is the surge in CPE colonization, rising from 0.02 to 0.78 per 10,000 patient-days over the same period. Healthcare-associated (HA) CPE infections have also been on the rise since 2019, increasing from 0.05 to 0.09 per 10,000 patient-days, with a disproportionate concentration within seven hospitals that accounted for 53% of all HA-CPE infections in 2023.
Identifying the Culprits
Carbapenemases were most frequently detected in Klebsiella pneumoniae (22%), Enterobacter cloacae complex (16%), and, most prominently, in organisms exhibiting chill (29%). The most common carbapenemase families identified were blaKPC (46%), blaNDM (29%), and blaOXA-48 (16%). These enzymes render bacteria highly resistant to carbapenems, a class of antibiotics often reserved as a last resort for severe infections.
The study points to nosocomial transmission – the spread of infection within a hospital setting – as the primary driver of this increase. “Our findings suggest that nosocomial transmission is driving the recent increase in CPE incidence in Canada,” the study authors wrote.
Patient Profile and Mortality
The median age of patients affected by CPE was 67 years, and a significant majority (84%) had pre-existing health conditions. The 30-day all-cause mortality rate among these patients was 19%. Notably, the majority of patients (66%) did not report recent international travel, and 74% had not received medical care abroad – factors previously linked to CPE acquisition. This suggests that the spread is occurring primarily within the Canadian healthcare system itself.
The observed exponential growth, researchers warn, is a clear indication that current infection-control protocols are inadequate. “Improved infection control measures and antimicrobial stewardship as well as access to newer antimicrobials are all urgently needed,” a senior official stated. The findings underscore the critical need for a multifaceted approach to combat this growing threat, including enhanced surveillance, stricter hygiene practices, and responsible antibiotic use.
