Antimicrobial use in Canadian acute-care hospitals: Findings from three national point-prevalence surveys between 2002 and 2017

• Published in: Infection control and hospital epidemiology 2022-11, Vol.43 (11), p.1558-1564
• Main Authors: Liang, Jennifer J., Rudnick, Wallis, Mitchell, Robyn, Brooks, James, Bush, Kathryn, Conly, John, Ellison, Jennifer, Frenette, Charles, Johnston, Lynn, Lavallée, Christian, McGeer, Allison, Mertz, Dominik, Pelude, Linda, Science, Michelle, Simor, Andrew, Smith, Stephanie, Stagg, Paula, Suh, Kathryn N., Thampi, Nisha, Thirion, Daniel J.G., Vayalumkal, Joseph, Wong, Alice, Taylor, Geoffrey
• Format: Article
• Language: English
• Subjects: Antibiotics; Antimicrobial agents; Confidence intervals; Drug resistance; Hospitals; Nosocomial infection; Nosocomial infections; Original; Original Article; Patients; Penicillin; Polls & surveys; Trends
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2021.519

The Canadian Nosocomial Infection Surveillance Program conducted point-prevalence surveys in acute-care hospitals in 2002, 2009, and 2017 to identify trends in antimicrobial use. Eligible inpatients were identified from a 24-hour period in February of each survey year. Patients were eligible (1) if they were admitted for ≥48 hours or (2) if they had been admitted to the hospital within a month. Chart reviews were conducted. We calculated the prevalence of antimicrobial use as follows: patients receiving ≥1 antimicrobial during survey period per number of patients surveyed × 100%. In each survey, 28-47 hospitals participated. In 2002, 2,460 (36.5%; 95% CI, 35.3%-37.6%) of 6,747 surveyed patients received ≥1 antimicrobial. In 2009, 3,566 (40.1%, 95% CI, 39.0%-41.1%) of 8,902 patients received ≥1 antimicrobial. In 2017, 3,936 (39.6%, 95% CI, 38.7%-40.6%) of 9,929 patients received ≥1 antimicrobial. Among patients who received ≥1 antimicrobial, penicillin use increased 36.8% between 2002 and 2017, and third-generation cephalosporin use increased from 13.9% to 18.1% (P < .0001). Between 2002 and 2017, fluoroquinolone use decreased from 25.7% to 16.3% (P < .0001) and clindamycin use decreased from 25.7% to 16.3% (P < .0001) among patients who received ≥1 antimicrobial. Aminoglycoside use decreased from 8.8% to 2.4% (P < .0001) and metronidazole use decreased from 18.1% to 9.4% (P < .0001). Carbapenem use increased from 3.9% in 2002 to 6.1% in 2009 (P < .0001) and increased by 4.8% between 2009 and 2017 (P = .60). The prevalence of antimicrobial use increased between 2002 and 2009 and then stabilized between 2009 and 2017. These data provide important information for antimicrobial stewardship programs.