Antimicrobial Resistance in Canada: Findings from the 2022 Canadian Antimicrobial Resistance Surveillance System Report
Antimicrobial resistance (AMR) is one of the top 10 global public health issues. Many existing antimicrobial drugs, such as antibiotics, are becoming less effective at treating infections, and drug-resistant pathogens continue to emerge.
Resistance can develop naturally over time; however, the inappropriate use of antimicrobials in human and veterinary medicine has greatly accelerated its emergence and spread across the human, animal and food chain. Antimicrobials are instrumental in medical advances and saving lives. Without effective antimicrobials, our ability to fight infectious diseases will significantly decline.
The Public Health Agency of Canada integrates and synthesizes information from its various surveillance systems and laboratory reference services that cover human, animal and food to present data on antimicrobial resistance and use in the human (hospital and community) and animal settings. The full 2022 Canadian Antimicrobial Resistance Surveillance System (CARSS) report presents data between 2016 and 2021.
Antimicrobial Resistance in Humans
Antimicrobial resistance for most priority organisms continued to increase over a five-year period.
The overall rate of methicillin-resistant Staphylococcus aureus bloodstream infections increased, driven by increases in community-associated infections since 2017.
Nearly 1 in 6 (17.5%) patients diagnosed with MRSA BSI died within 30 days of diagnosis (all-cause mortality).
Figure 1. Incidence rates of overall, healthcare-associated and community-associated methicillin-resistant Staphylococcus aureus bloodstream infections, CNISP, 2016-2020.
Table 1. Incidence rates of overall, healthcare-associated and community-associated methicillin-resistant Staphylococcus aureus bloodstream infections, CNISP, 2016-2020.
Following a sustained increase, the overall rate of Vancomycin-resistant Enterococcus bloodstream infections in hospitalized patients appears to have plateaued during the COVID-19 pandemic (2019 and 2020).
While overall numbers remain low, the rate of healthcare-associated carbapenemase-producing Enterobacterales infection in hospitalized patients appears to have decreased during the COVID-19 pandemic (2019 and 2020) reversing the increasing trend that had been observed since 2016.
Following a sustained decrease from 2016 to 2019, healthcare-associated rates of Clostridioides difficile infections increased during the COVID-19 pandemic (2019 to 2020).
Antibiotic Susceptibility Rates of Bacteria causing Bloodstream Infections, 2020
Strains of E. coli, K. pneumoniae, and S. aureus isolated from bloodstream infections in Canadians exhibit high levels of resistance to first line antibiotics.
Figure 5. Antimicrobial susceptibility results from blood stream isolates from the Canadian AMRNet surveillance program, 2020.
Table 5. Antimicrobial susceptibility results from blood stream isolates from the Canadian AMRNet surveillance program, 2020.
Figure 5: Text description
Antibiotic
Bacterial species
Antibiotic Use and Frequency
Antibiotic use is very common. About a third of Canadians (33.9%) reported antibiotic use in the past 12 months, 2021-2022.
More than 1 in 7 used antibiotics twice or more.
Close to 1 in 20 used antibiotics more than five times.
In 2008, 38.0% of Canadians reported having taken antibiotics in the 12 months, showing that the proportion of Canadians reporting antibiotic use has declined slightly since then.
Figure 6. Antibiotic use among Canadians (18+)
Table 6. Antibiotic use among Canadians (18+)
Figure 6: Text description
Antibiotic use frequency
Percentage of respondants
Antibiotic Knowledge and Attitudes
Misinformation about antibiotics is common. More than 1 in 4 people mistakenly believe antibiotics are effective against colds, flus, and viruses.
Antimicrobial Use in Humans
Human Antimicrobial Use is Decreasing
Between 2017 and 2021, a decrease in antimicrobial consumption of 26.9% was observed in all Canadian jurisdictions, most pronounced during the COVID-19 pandemic (2019 to 2021).
Figure 7. Antimicrobial consumption by humans (DDDs per 1,000 inhabitants per day), IQVIA, 2017–2021.
Table 7. Antimicrobial consumption by humans (DDDs per 1,000 inhabitants per day), IQVIA, 2017–2021.
Figure 7: Text description
Human population category
Year
2017
2018
2019
2020
2021
Canada continues to meet the World Health Organization’s target of <40% of total consumption of drugs being in the AWaRe Watch (26.4%) and Reserve (0.2%) category.
Only 26.6% of prescriptions in 2021 classified as Watch or Reserve.
Figure 8. Percentage of antibiotics prescribed stratified by AWaRe classification, 2021.
Table 8. Percentage of antibiotics prescribed stratified by AWaRe classification, 2021.
Figure 8: Text description
AWaRe classification
Percentage
What is AWaRe?
Access antibiotics are used for a wide range of common infectious diseases and show lower resistance potential than antibiotics in other groups.
Watch antibiotics are recommended only for specific bacterial infections due to their higher resistance potential.
Reserve antibiotics are recommended as a last resort, the use of which needs to be monitored and tailored to specific patients and settings, when all alternatives have failed or are not suitable.
Inappropriate Prescribing is Common.
Data from the National Antimicrobial Prescribing Survey (NAPS) suggest that 22.5% of prescriptions were deemed inappropriate in participating Canadian hospitals.
Figure 9. Appropriateness of Hospital Antibiotic Prescriptions by Regions and Canada, 2018-2021.
Table 9. Appropriateness of Hospital Antibiotic Prescriptions by Regions and Canada, 2018-2021.
Figure 9: Text description
Region
Appropriateness
Appropriate
Inappropriate
Antimicrobial Resistance in Animals
Antimicrobial Resistance in Healthy Animals Decreased
Based on volunteer sentinel farm surveillance, a key metric for antimicrobial resistance showed a decreasing trend between 2016 and 2020 in healthy broiler chickens, turkeys and grower-finisher pigs.
Figure 10. Antimicrobial resistance from broiler chicken farms (n = 135 average farms/year), grower-finisher pig farms (n = 95 average farms/year) and turkey farms (n = 805 average farms/year), 2016-2020.
Table 10. Antimicrobial resistance from broiler chicken farms (n = 135 average farms/year), grower-finisher pig farms (n = 95 average farms/year) and turkey farms (n = 805 average farms/year), 2016-2020.
Figure 10: Text description
Animal species
Year
2016
2017
2018
2019
2020
Antimicrobial Use in Animals
Antimicrobials Sold for Use in Animals is Increasing
From 2019 to 2020, the quantity of medically important antimicrobials (MIAs) sold for use in animals increased slightly by 6.5%. Sales of antimicrobials for use in poultry decreased, while sales for use in pigs and cattle increased.
In 2020, the quantity of antimicrobials sold in Canada (mg/PCU) for production animals was three times higher than the median of the 31 European countries.
Figure 11. Quantity (kg) of medically important antimicrobials sold for use in animals by animal species, Canada, 2019-2020
Table 11. Quantity (kg) of medically important antimicrobials sold for use in animals by animal species, Canada, 2019-2020
