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Chapter 1. Design and Methods

Summary of Design and Methods Changes Over Time

Table 8. Changes implemented since the beginning of the Antimicrobial Resistance (AMR) Surveillance program
Year Component Province / region Species Selected bacteria Design Methods
Escherichia  coli Salmonella Campylobacter  Enterococcus
2012 Surveillance of Human Clinical Isolates Across provinces Humans   •       "Adoption of a lower breakpoint for ciprofloxacin (≥ 1 µg/mL; CLSI M100-S22) than in past years ( ≥ 4 µg/mL) for both Salmonella and E. coli. Ciprofloxacin's new breakpoint was applied to all data, including historical data.Then, the term "reduced susceptibility to ciprofloxacin" was dropped."
Retail Surveillance British Columbia
Saskatchewan
Ontario
Québec
Maritimes		 Beef •        
Chicken • • •    
Pork •        
Turkey • • •   Surveillance of Salmonella, E. coli and Campylobacter isolates in retail turkey was started in January.
Abattoir Surveillance Across provinces Beef cattle •   •   Surveillance of Campylobacter in pigs at the abattoir was started in January.
Chickens • • •  
Pigs • • •  
Farm Surveillance British Columbia
Saskatchewan
Ontario
Québec
Maritimes		 Pigs • •      
Surveillance of animal clinical Isolates Across provinces Bovine   •    
Chickens   •    
Pigs   •    
Turkeys   •    
Feed and Feed Ingredients Across provinces     •    
2011 Surveillance of Human Clinical Isolates Across provinces Humans   •     Human serovars : Newport added as a separate category The CMV2AGNF susceptibility testing plate has replaced the CMV1AGNF plate for Salmonella and E. coli. Amikacin was removed and azithromycin was included in the panel.
Farm Surveillance Alberta
Saskatchewan
Manitoba
Ontario
Québec		 Pigs       x Bacterial culture and antimicrobial susceptibility testing of Enterococcus isolates from pigs were discontinued as of January.
2010 Surveillance of Human Clinical Isolates Across provinces Humans   •     Isolates classified as "Other serovars" category were not tested or reported, but stored for future AMR testing. Half of the Salmonella Enteritidis submitted by the most populated provinces (British Columbia, Alberta, Ontario, and Québec) during the first 15 days of the month were tested.
Retail Surveillance British Columbia
Saskatchewan
Ontario
Québec
Maritimes		 Beef •       Bacterial culture and antimicrobial susceptibility testing of Enterococcus in chicken isolates discontinued as of January (no vancomycin resistance was detected since the program began in 2003). A new ceftriaxone breakpoint was officially adopted by the CLSI in January 2010. It was applied to all data, including historical data. A new genus- and species-specific multiplex PCR method was used in replacement of the standard method (biochemical tests) to perform identification and speciation of Campylobacter.
Chicken • • • x
Pork •      
Abattoir Surveillance Across provinces Beef cattle •   •   Bacterial culture and antimicrobial susceptibility testing of Campylobacter isolates from abattoir chickens was initiated in January.
Chickens • • •  
Pigs • •    
2009 Surveillance of Human Clinical Isolates Across provinces Humans   •     Human serovars: Newport not presented as a separate category; now included with the "other serovars"  
Retail Surveillance British Columbia
Saskatchewan
Ontario
Québec
Maritimes		 Beef •       First full surveillance year in the Maritimes. The CMV3AGPF susceptibility testing plate has replaced the CMV2AGPF plate for all Enterococcus isolates.
Chicken • • • •
Pork •      
Farm Surveillance Alberta
Saskatchewan
Manitoba
Ontario
Québec		 Pigs • •   • Sample collection from pigs on entry to the Grower-Finisher unit was terminated. Changed from 3 herd visits per year to 1 annual visit to collect fecal samples from close-to-market pigs.  
2008 Surveillance of Human Clinical Isolates Across provinces Humans   •     Human serovars: Paratyphi A and B reported as a separate category along with Enteritidis, Heidelberg, Newport, Typhi, Typhimurium, and Other Serovars. The ceftriaxone resistance breakpoint was changed to ≥ 4 µg/mL (CLSI M100-S20) for all Salmonella and Escherichia coli isolates. Quinupristin-dalfopristin was reclassified as Category II antimicrobial (High Importance in Human Medicine, Veterinary Drugs Directorate, Health Canada) for all Enterococcus isolates. Application of a more sensitive Campylobacter recovery method in abattoir beef cattle isolates. Quinupristin-dalfopristin reclassified as category II for all Enterococcus isolates.
Retail Surveillance British Columbia
Saskatchewan
Ontario
Québec
Maritimes (pilot)		 Beef •       First surveillance year in British Columbia. Pilot surveillance also began in the Maritimes region in September 2008.
Chicken • • • •
Pork •      
2007 Retail Surveillance British Columbia
(pilot)
Saskatchewan
Ontario
Québec		 Beef •       Implementation of pilot retail surveillance in British Columbia.  
Chicken • • • • Retail surveillance: Enhancement to the Salmonella recovery method yielded higher recovery rates than in prior years. For antimicrobial susceptibility testing of Enterococcus, bacitracin was removed and tigecycline removed from the panel. New resistance breakpoints were adopted for lincomycin (from ≥ 32 to ≥ 8 ≥g/mL) and kanamycin (from ≥ 512 to ≥ 1,024 ≥g/mL).
Pork •        
Surveillance of animal clinical Isolates Across provinces Bovine   •        
Chickens   •        
Pigs   •        
Turkeys   •        
Horses   •     Publication of surveillance findings from clinical isolates from horses.  
Feed and Feed Ingredients Across provinces Not available   •     Feed and Feed Ingredients presented as a separate surveillance component.  
2006 Retail Surveillance Saskatchewan
Ontario
Québec		 Beef •          
Chicken • • • •   The NARMS CAMPY plate has replaced the disk diffusion method (Etest) for antimicrobial susceptibility testing of Campylobacter.
Pork • •        
Abattoir Surveillance Across provinces Beef cattle •   •   Abattoir surveillance of Campylobacter from beef cattle was started in January  
Chickens • •        
Pigs • •        
Farm Surveillance Alberta
Saskatchewan
Manitoba
Ontario
Québec		 Pigs • •   • Implementation of the CIPARS farm component in grower-finisher pigs of the 5 major pork producing provinces.  
2005 Retail Surveillance Saskatchewan
Ontario
Québec		 Beef •       Addition of Saskatchewan to the retail component. Antimicrobial susceptibility testing of Salmonella and E. coli was fully performed by the NARMS CMV1AGNF plate in January.
Chicken • • • •
Pork • •    
Abattoir Surveillance Across provinces Beef cattle •   •   Pilot surveillance of Campylobacter from beef cattle started in late 2005.
Chickens • •    
Pigs • •    
2004 Surveillance of Human Clinical Isolates Across provinces Humans   •       Antimicrobial susceptibility testing of human Salmonella was performed by the NARMS CMV7CNCD from January to April and the CMV1AGNF from April to December.
Abattoir Surveillance Across provinces Beef cattle • x     Salmonella isolation discontinued because of its low prevalence in beef cattle.  
Chickens • •        
Pigs • •        
Retail Surveillance Ontario
Québec		 Beef •       There is a systematic rotational selection of extra lean, lean, regular, and medium ground beef.  
Chicken • • • •    
Pork •          
2003 Surveillance of Human Clinical Isolates Across provinces Humans   •     Implementation of the CIPARS human component. Antimicrobial susceptibility testing done on all serovars but they were classified and reported into the following categories: Enteritidis, Heidelberg, Newport, Typhi, Typhimurium, and Other Serovars. "Susceptibility testing of Campylobacter and Enterococcus was performed with the disk diffusion method using the ETest® methodology (AB Biodisk, Solna, Sweden) and the NARMS CMV5ACDC plate respectively. "
Retail Surveillance Ontario
Québec		 Beef •       Implementation of the CIPARS human component. Antimicrobial susceptibility testing done on all serovars but they were classified and reported into the following categories: Enteritidis, Heidelberg, Newport, Typhi, Typhimurium, and Other Serovars.
Chicken • • • •
Pork •      
2002 Surveillance of Human Clinical Isolates Across provinces Humans         Agreement signed with the Provinces to send all (or a subset) of Salmonella isolates to CIPARS. Data were not available for reporting that year.  
Abattoir Surveillance Across provinces Beef cattle • •     Implementation of the first active suveillance component of CIPARS. Antimicrobial susceptibility testing of Salmonella and E. coli was performed by the CMV7CNCD plate (Sensititre™), NARMS, United States.
Chickens • •    
Pigs • •    
Surveillance of animal clinical Isolates Across provinces Cattle   •     Implementation of the first passive suveillance components of CIPARS.  
Chickens   •    
Pigs   •    
Turkeys   •    
Feed and Feed Ingredients   •    
Table 9. Changes implemented since the beginning of the Antimicrobial Use (AMU) Surveillance program
Year Component Province / region Population exposed Reporting metrics Dosage information Design Methods
2011 Human antimicrobial use surveillance -Physician diagnosis data National Provincial Regional s Canadians 1) Total diagnoses/10,000 inhabitants
2) Total antimicrobial recommendations/10,000 inhabitants
3) Percentage diagnoses with antimicrobial recommendations		   Enhancement of the Human antimicrobial use surveillance component. The design is based on a sample of physicians providing antimicrobial recommendation information for every patient in a 48-hour period four times a year. Analysis based on the Canadian Disease and Therapeutic Index (CDTI) purchased from IMS Health Canada Inc.
Human antimicrobial use surveillance -Hospital purchases National Provincial Canadians 1) Defined Daily Doses (DDD)/1,000 inhabitant-days
2) Total cost/1,000 inhabitant-days
3) Total cost per unit of antimicrobials
4) Total active ingredient (kg)		   Enhancement of the Human antimicrobial use surveillance component. The design is based on a purchasing information for a number of Canadian hospitals extrapolated to all hospitals in Canada. Analysis based on the Canadian Drugstore and Hospital Purchases Audit (CDH) purchased from IMS Health Canada Inc.
Surveillance of the antimicrobials distributed for sale for animals National A national animal biomass denominator was calculated as per the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) 1) Total of active ingredients (kg) (national and provincial; production animal, and companion animal); 2) mg/PCU (where PCU=population correction unit, a measure of animal biomass)     Stratification of CAHI data into production & companion animal; stratification by province; extraction of cephalosporins back into separate category; application of biomass denominator to national-level data.
2009 Farm AMU surveillance in Pigs Alberta
Saskatchewan
Manitoba
Ontario
Québec		 Number of grower-finisher pigs at start and end of grow, mortalities and culls Farm count data for antimicrobial use by class, category of importance to human medicine, and reason for use Inclusion rate in feed (g/tonne) Annual and Sampling Day questionnaires were complied into a single Sampling Day Questionnaire which is applied once/herd/year. Inclusion rate in feed ONLY; no dosage information collected for water or injections
2008 Surveillance of the antimicrobials distributed for sale for animals National Not applicable       CAHI has a "3 company accounting rule" to comply with the EU & the US' anti-competition regulations. CAHI added in some cases a "90% rule" to be sure not to infringe upon the regulations in the US. These accounting rules can result in changes to the categorization of specific antimicrobials over time.
2007 Human antimicrobial use surveillance -Pharmacy sale National Provincial Canadians "1) Prescriptions/1,000 inhabitants
2) Defined daily doses (DDDs)/1,000 inhabitant-days
3) Total cost/1,000 inhabitant-days
4) Total active ingredients (kg)" 		    Data are now available separately for Newfoundland & Labrador and Prince Edward Island.
Farm AMU surveillance in Pigs Alberta
Saskatchewan
Manitoba
Ontario
Québec		 Number of grower-finisher pigs at start and end of grow, mortalities and culls Farm count data for AMU by class, category of importance to human medicine, and reason for use Inclusion rate in feed and water (not collected for injections)   Questionnaire was refined to improve data quality and compliance.
2006 Farm AMU surveillance in Pigs Alberta
Saskatchewan
Manitoba
Ontario
Québec		 Number of grower-finisher pigs at start and end of grow, mortalities and culls Farm count data for AMU by class, category of importance to human medicine, and reason for use Inclusion rate in feed and water (not collected for injections) Implementation of the CIPARS farm component in grower-finisher pigs of the 5 major porc producing provinces. Antimicrobial use in feed, water, and injection information was collected through 1 annual and 3 sampling day questionnaires/herd/year.
Surveillance of the antimicrobials distributed for sale for animals National Not applicable 1) Total of active ingredients (kg) Not available Implementation of surveillance of manufacturer and distributor-level data for antimicrobials used in animals as provided by the Canadian Animal Health Institute (CAHI)  
2005 Human antimicrobial use surveillance - Pharmacy sale National Canadians "1) Prescriptions/1,000 inhabitants
2) Defined daily doses (DDDs)/1,000 inhabitant-days
3) Total cost/1,000 inhabitant-days
4) Total active ingredients (kg)" 		  Implementation of the Human antimicrobial use surveillance component. The design is based on a number of canadian pharmacies dispensing oral prescriptions extrapolated to all pharmacies in Canada. Implementation of the Human antimicrobial use surveillance component. The design is based on a number of canadian pharmacies dispensing oral prescriptions extrapolated to all pharmacies in Canada. Analysis based on the Canadian CompuScript (CCS) purchased from IMS Health Canada Inc.

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