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Antimicrobial Agents and Chemotherapy, April 2008, p. 1430-1437, Vol. 52, No. 4
0066-4804/08/$08.00+0     doi:10.1128/AAC.01538-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Antimicrobial-Resistant Pathogens in Intensive Care Units in Canada: Results of the Canadian National Intensive Care Unit (CAN-ICU) Study, 2005-2006{triangledown}

George G. Zhanel,1,2,3* Mel DeCorby,1,3 Nancy Laing,1,3 Barb Weshnoweski,3 Ravi Vashisht,1,3 Franil Tailor,3 Kim A. Nichol,3 Aleksandra Wierzbowski,1,3 Patricia J. Baudry,1,3 James A. Karlowsky,1,3 Philippe Lagacé-Wiens,1,3 Andrew Walkty,1,3 Melissa McCracken,4 Michael R. Mulvey,4 Jack Johnson,5 The Canadian Antimicrobial Resistance Alliance (CARA), and Daryl J. Hoban1,3

Department of Medical Microbiology, Faculty of Medicine, University of Manitoba,1 Departments of Medicine,2 Clinical Microbiology, Health Sciences Centre, Winnipeg, Manitoba, Canada,3 Nosocomial Infections Branch, National Microbiology Laboratory, Winnipeg, Manitoba, Canada,4 International Health Management Associates, Chicago, Illinois5

Received 28 November 2007/ Returned for modification 18 January 2008/ Accepted 10 February 2008

Between 1 September 2005 and 30 June 2006, 19 medical centers collected 4,180 isolates recovered from clinical specimens from patients in intensive care units (ICUs) in Canada. The 4,180 isolates were collected from 2,292 respiratory specimens (54.8%), 738 blood specimens (17.7%), 581 wound/tissue specimens (13.9%), and 569 urinary specimens (13.6%). The 10 most common organisms isolated from 79.5% of all clinical specimens were methicillin-susceptible Staphylococcus aureus (MSSA) (16.4%), Escherichia coli (12.8%), Pseudomonas aeruginosa (10.0%), Haemophilus influenzae (7.9%), coagulase-negative staphylococci/Staphylococcus epidermidis (6.5%), Enterococcus spp. (6.1%), Streptococcus pneumoniae (5.8%), Klebsiella pneumoniae (5.8%), methicillin-resistant Staphylococcus aureus (MRSA) (4.7%), and Enterobacter cloacae (3.9%). MRSA made up 22.3% (197/884) of all S. aureus isolates (90.9% of MRSA were health care-associated MRSA, and 9.1% were community-associated MRSA), while vancomycin-resistant enterococci (VRE) made up 6.7% (11/255) of all enterococcal isolates (88.2% of VRE had the vanA genotype). Extended-spectrum β-lactamase (ESBL)-producing E. coli and K. pneumoniae occurred in 3.5% (19/536) and 1.8% (4/224) of isolates, respectively. All 19 ESBL-producing E. coli isolates were PCR positive for CTX-M, with blaCTX-M-15 occurring in 74% (14/19) of isolates. For MRSA, no resistance against daptomycin, linezolid, tigecycline, and vancomycin was observed, while the resistance rates to other agents were as follows: clarithromycin, 89.9%; clindamycin, 76.1%; fluoroquinolones, 90.1 to 91.8%; and trimethoprim-sulfamethoxazole, 11.7%. For E. coli, no resistance to amikacin, meropenem, and tigecycline was observed, while resistance rates to other agents were as follows: cefazolin, 20.1%; cefepime, 0.7%; ceftriaxone, 3.7%; gentamicin, 3.0%; fluoroquinolones, 21.1%; piperacillin-tazobactam, 1.9%; and trimethoprim-sulfamethoxazole, 24.8%. Resistance rates for P. aeruginosa were as follows: amikacin, 2.6%; cefepime, 10.2%; gentamicin, 15.2%; fluoroquinolones, 23.8 to 25.5%; meropenem, 13.6%; and piperacillin-tazobactam, 9.3%. A multidrug-resistant (MDR) phenotype (resistance to three or more of the following drugs: cefepime, piperacillin-tazobactam, meropenem, amikacin or gentamicin, and ciprofloxacin) occurred frequently in P. aeruginosa (12.6%) but uncommonly in E. coli (0.2%), E. cloacae (0.6%), or K. pneumoniae (0%). In conclusion, S. aureus (MSSA and MRSA), E. coli, P. aeruginosa, H. influenzae, Enterococcus spp., S. pneumoniae, and K. pneumoniae are the most common isolates recovered from clinical specimens in Canadian ICUs. A MDR phenotype is common for P. aeruginosa isolates in Canadian ICUs.

* Corresponding author. Mailing address: Clinical Microbiology, Health Sciences Centre, MS673-820 Sherbrook St., Winnipeg, Manitoba R3A 1R9, Canada. Phone: (204) 787-4902. Fax: (204) 787-4699. E-mail: ggzhanel{at}pcs.mb.ca

{triangledown} Published ahead of print on 19 February 2008.

Antimicrobial Agents and Chemotherapy, April 2008, p. 1430-1437, Vol. 52, No. 4
0066-4804/08/$08.00+0     doi:10.1128/AAC.01538-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



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