Antimicrobial-Resistant Pathogens in Intensive Care Units in Canada: Results of the Canadian National Intensive Care Unit (CAN-ICU) Study, 2005-2006
Authors: Zhanel George G. , DeCorby Mel , Laing Nancy , Weshnoweski Barb , Vashisht Ravi , Tailor Franil , Nichol Kim A. , Wierzbowski Aleksandra , Baudry Patricia J. , Karlowsky James A. , Lagacé-Wiens Philippe , Walkty Andrew , McCracken Melissa , Mulvey Michael R. , Johnson Jack ,   The Canadian Antimicrobial Resistance Alliance (CARA), Hoban Daryl J. 
Published: February 2008

ABSTRACT

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
bla
CTX-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.