Footnotes: 2008 Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) annual report

Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS)

Footnotes

Footnote note1

Centre for Foodborne, Environmental and Zoonotic Infectious Diseases

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Footnote note2

Laboratory for Foodborne Zoonoses

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Footnote note3

National Microbiology Laboratory

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Footnote note4

Escherichia coli were identified by use of biochemical tests. No attempt was made to distinguish pathogenic strains of E. coli from non-pathogenic strains.

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Footnote note5

The MIC is the lowest concentration of an antimicrobial that inhibits visible bacterial growth after incubation.

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Footnote note6

Ceftiofur is licensed for use in animals only. Resistance to ceftiofur is generally detected in combination with resistance to amoxicillin-clavulanic acid, cefoxitin, ampicillin and ceftriaxone (A2C-AMP-CRO resistance pattern).

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Footnote note7

World Health Organization. The Anatomical Therapeutic Chemical Classification System with Defined Daily Doses ( ATC/ DDD). Available at: www.who.int/classifications/atcddd/en/ . Accessed October 2010.

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Footnote note8

The current CLSI resistance breakpoint for this antimicrobial and the one adopted in this report is ≥ 4 μg/mL. However, the Danish Integrated Antimicrobial Resistance Monitoring and Research Program ( DANMAP) has used a resistance breakpoint of ≥ 0.125 μg/mL for both Salmonella spp. and indicator E. coli since 2004 and for pathogenic E. coli since 2006. The DANMAP also introduced European Committee on Antimicrobial Susceptibility Testing epidemiological cutoff values in their 2007 report. Because of the clinical importance of ciprofloxacin and a desire to present results in a format comparable with those of DANMAP, the term "reduced susceptibility" is used for ciprofloxacin MICs from 0.125 to 2 μg/mL. To obtain resistance estimates comparable to those from DANMAP, the percentage of E. coli and Salmonella isolates in this report with reduced susceptibility must be added to the percentage of isolates resistant to ciprofloxacin.

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Footnote note9

Public Health Agency of Canada. Salmonella Heidelburg Ceftiofur-Related Resistance in Human and Retail Chicken Isolates. Available at: www.phac-aspc.gc.ca/cipars-picra/heidelberg/heidelberg-eng.php. Accessed October 2010.

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Footnote note10

"Fluoroquinolone-susceptible strains of Salmonella that test resistant to nalidixic acid may be associated with clinical failure or delayed response in fluoroquinolone-treated patients with extra-intestinal salmonellosis. Extra-intestinal isolates of Salmonella should also be tested for resistance to nalidixic acid. For isolates that test susceptible to fluoroquinolones and resistant to nalidixic acid, the physician should be informed that the isolate may not be eradicated by fluoroquinolone treatment." (CLSI M100-S16).

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Footnote note11

Public Health Agency of Canada, Salmonella paratyphi Material Safety Data Sheet. Available at: www.phac-aspc.gc.ca/msds-ftss/msds133e-eng.php. Accessed November 2010.

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Footnote note12

Does not include S. Paratyphi B var. L (+) tartrate+, formerly called S. Paratyphi var. Java. The biotype of S. Paratyphi B included here is tartrate (-) and is associated with more severe, typhoid-like fever. Salmonella Paratyphi B var. L (+) tartrate+ is commonly associated with gastroenteritis. Because animals can be a source of this serovar, it is included under "Other Serovars."

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Footnote note13

2004 and 2006 were selected as years of comparison for ceftiofur and ampicillin resistance because of a change in ceftiofur use practices by Québec chicken hatcheries in early 2005 and in 2006 (start and end of the voluntary period of withdrawal).

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Footnote note14

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Footnote note15

Distribution of Salmonella isolates across provinces is presented in , .

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Footnote note16

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Footnote note17

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Footnote note18

Distribution of Salmonella isolates across provinces is presented in , .

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Footnote note19

Isolates recovered from retail chicken in the Maritimes region underwent antimicrobial susceptibility testing, but results are not presented in this report because of concerns regarding harmonization of laboratory methods for 2008 only.

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Footnote note20

Isolates recovered from retail chicken in the Maritimes region underwent antimicrobial susceptibility testing but results are not presented in this report because of concerns surrounding harmonization of laboratory methods for 2008 only.

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Footnote note21

The percentages provided in the text and in the figures and tables were adjusted to account for clustering within herds, whereas proportions represent unadjusted values (see Appendix A).

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Footnote note22

Because few isolates were recovered in 2003 (2%, 2/125), testing was stopped in 2004 and 2005. However, given increasing concern and interest associated with Salmonella in pork, testing was reinitiated in 2006. In 2007, a new method of isolate recovery was implemented for all retail meat samples. For a summary of recovery by year and province, see , .

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Footnote note23

Because of the low prevalence of Salmonella detected in pork, antimicrobial susceptibility results for the few isolates recovered each year are not presented on an annual basis. Rather, 6 years of results have been pooled together and are presented here.

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Footnote note24

Distribution of Salmonella isolates across provinces is presented in , .

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Footnote note25

The number of generic E. coli isolates recovered through Farm Surveillance was much higher than through other surveillance components. The reason for collecting a larger number of isolates in Farm Surveillance is to ensure adequate power to investigate the association between antimicrobial resistance and antimicrobial use. A large number of isolates facilitates the identification of statistically significant small changes (such as plus or minus 0.5%), particularly when the prevalence of resistance is around 1%. Although significant, the increase in ceftiofur resistance between 2007 and 2008 (from less than 1% to 1%) may simply reflect natural variation from year to year.

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Footnote note26

The percentages provided in the text and in the figures and tables were adjusted to account for clustering within herds, whereas proportions represent unadjusted values (see Appendix A).

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Footnote note28

Distribution of Salmonella isolates across provinces is presented in , .

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Footnote note30

Defined daily dosages were computed from data on dispensed prescriptions for orally administered antimicrobials. However, an unknown proportion of the drugs sold by retail pharmacies is not consumed. To improve text clarity, the word "consumption" is used, although the total DDD estimates presented slightly overestimate true consumption.

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Footnote note31

European Surveillance of Antimicrobial Consumption. ESAC Yearbook 2007. Available at: www.esac.ua.ac.be/main.aspx?c=*ESAC2&n=50036 . Accessed March 2010. Note: Data were available for Malta but were not included in the comparisons because the numbers were too low (i.e. 1.7 DDDs/1,000 inhabitants).

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Footnote note32

Other animal demographic information is presented in and , .

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Footnote note33

See: www.phac-aspc.gc.ca/cipars-picra/2006-eng.php. Accessed December 2010.

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Footnote note34

Division of AgLine/TI Communications Ltd. See: www.impactvet.com. Accessed August 2009.

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Footnote note35

For ceftriaxone, analysis was done based on a resistance breakpoint of 64 µg/mL.

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Footnote note36

Version April, 2009. Available at: www.hc-sc.gc.ca/dhp-mps/consultation/vet/consultations/amr_ram_hum-med-rev-eng.php. Accessed February 2010.

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Footnote note37

Report of the 2001 Canadian Laboratory Study, National Studies on Acute Gastrointestinal Illness, Division of Enteric, Foodborne and Waterborne Diseases, 2002.

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Footnote note38

Agriculture and Agri-Food Canada. Red meat market information. Available at: www.agr.gc.ca/redmeat-vianderouge/index_eng.htm . Accessed November 2010.

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Footnote note39

When legs with skin on were not available, wings with skin on or other cuts of chicken were purchased instead.

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Footnote note40

At 1 store in each division, the beef sample was not collected to minimize over-sampling of this commodity.

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Footnote note41

When legs with skin on were not available, wings with skin on or other cuts were purchased instead.

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Footnote note42

Office Internationale des Épizooties, OIÉ; All World Organisation for Animal Health, Reference Laboratory for Salmonellosis, Guelph, Ontario.

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Footnote note43

World Health Organization Collaborating Center for Drug Statistics Methodology. Available at: www.whocc.no/atcddd. Accessed October 2010.

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Footnote note44

Veterinary Drugs Directorate. Categorization of Antimicrobial Drugs Based on Importance in Human Medicine. Version of April 2009. See: www.hc-sc.gc.ca/dhp-mps/consultation/vet/consultations/amr_ram_hum-med_e.html. Accessed October 2010.

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Footnotes: 2008 Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) annual report

Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS)

Footnotes

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