Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) 2017: Integrated Findings

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To promote and protect the health of Canadians through leadership, partnership, innovation and action in public health, Public Health Agency of Canada.

Working towards the preservation of effective antimicrobials for humans and animals, Canadian Integrated Program for Antimicrobial Resistance Surveillance.

Également disponible en français sous le titre :

Programme intégré canadien de surveillance de la résistance aux antimicrobiens (PICRA) 2017 : Résultats intégrés

To obtain additional information, please contact:

Dolly Kambo
Executive assistant
Public Health Agency of Canada
370 Speedvale Avenue West, Guelph, ON N1H 7M7
Telephone: 519-826-2174
Fax: 519-826-2255
E-mail: phac.cipars-picra.aspc@canada.ca

This publication can be made available in alternative formats upon request.

^©Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2020

Publication date: January 2020

This publication may be reproduced for personal or internal use only without permission provided the source is fully acknowledged.

Cat.: HP2-4/2017E-2-PDF
PDF ISBN: 978-0-660-32669-6
Pub.: 190361

Suggested Citation:

Government of Canada. Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) 2017: Integrated Findings. Public Health Agency of Canada, Guelph, Ontario, 2020.

On this page

• Overview of CIPARS activities
• What's new for CIPARS in 2017
  • Antimicrobial use
  • Antimicrobial resistance
• 2017 Key findings
  • Antimicrobial use
  • Antimicrobial resistance
  • Integrated Antimicrobial Use and Resistance Data
• Integrated findings and discussion
  • Integrated antimicrobial use
  • Integrated antimicrobial resistance data
  • Integrated antimicrobial use and resistance data
• Glossary

Overview of CIPARS activities

Figure 1 - Text Description

CIPARS brings together diverse sources of data in a robust and sound manner

This diagram represents all of the surveillance components that contribute to the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS). The top half of the figure depicts all of the surveillance components related to antimicrobial resistance. On the left side, a component of passive surveillance (green arrows) associated with clinical samples of Salmonella (green circle) and Campylobacter (red triangle) of human origin is presented. These human samples are taken during the medical visit and sent to a local laboratory, then to a provincial/territorial laboratory, and finally to the National Microbiology Laboratory of Public Health Agency of Canada (PHAC) in Winnipeg. On the right side, there is a passive surveillance component (green arrows) and three active surveillance components (yellow arrows) from the Agri-Food sector. The passive surveillance component (green arrows) relies on clinical samples from sick animals (cattle, pigs, chickens, horses, and turkeys) that are submitted to provincial or private animal health laboratories for the isolation of Salmonella (green circle). Further on the right are presented the active surveillance components (yellow arrows) based on animal samples from the farm (cattle, pigs, chickens and turkeys), the abattoir (beef cattle, chickens, pigs) and also on retail meat samples (beef, pork, chicken and turkey). In general, samples from diseased animals are sent to the PHAC National Microbiology Laboratory in Guelph through provincial or private animal health laboratories. For other Agri-Food samples, most will be sent directly to the Saint-Hyacinthe National Microbiology Laboratory of the PHAC for the isolation of Salmonella (green circle), Campylobacter (red triangle), and Escherichia coli (green square).

The bottom of the diagram lists the surveillance components for antimicrobial use. On the left, three components related to the use of antimicrobials in humans and based on physician diagnostic data, hospital purchases and pharmacy sales data are shown. The data from humans are analyzed by the Canadian Antimicrobial Resistance Surveillance System of the PHAC and will be integrated with other CIPARS data. In the center, there is a component that monitors antimicrobials distributed for sale for use in crops. These data are processed by Health Canada's Pest Management Regulatory Agency and are also incorporated into some CIPARS data. There is also a component that monitors antimicrobials distributed to animals. This includes antimicrobials distributed for sale for use in production animals (cattle, pigs, chickens, turkey, etc.) and companion animals (dogs, cats, horses, etc.). The latter are processed by the Canadian Animal Health Institute and are sent to CIPARS for further integration. On the right, there are two surveillance components related to antimicrobial use on farm, the finfish antimicrobial use data (processed by Fisheries and Oceans Canada) and the sentinel flock antimicrobial use data (cattle, pigs, chickens and turkeys).

The central section of this diagram illustrates the collection of all data related to antimicrobial resistance and antimicrobial use within the CIPARS program. All data collected are integrated to figure out trend evolution and status of antimicrobial resistance and use in humans and the agri-food sector in Canada.

What's new for CIPARS in 2017

We are modernizing how we share our information with different audiences and are transitioning to new communication tools and formats. In the meantime, CIPARS will continue to deliver the same information, but in a modified manner.

For the 2017 data, we will be releasing 4 documents:

• Executive summary
• Figures and Tables (summarized information with little accompanying text)
• Design and Methods
• Integrated Findings

Antimicrobial use

• Fisheries and Oceans Canada provided data on antimicrobial use in marine and freshwater finfish aquaculture.

Antimicrobial resistance

• Only a partial year of retail sampling was conducted in Ontario and the Prairies, and no sampling occurred in the Atlantic region.
• Sampling for Campylobacter spp. from retail ground turkey was discontinued due to low recovery.

2017 Key findings

Antimicrobial use

In 2017, fewer farms participating in CIPARS surveillance reported using antimicrobials:

• Antimicrobial sales decreased between 2016 and 2017
• For broiler chicken and pig farms participating in CIPARS surveillance, the overall reported quantity of antimicrobials used declined. For turkey farms participating, there was a small increase in the overall reported use
• The types of antimicrobials used varied by animal species
• Based on sentinel farm data, antimicrobial use in turkeys was generally lower than antimicrobial use in broiler chickens

The reductions in antimicrobial use on broiler chicken and pig farms may be in response to new policy regulations for medically important antimicrobials (eliminating use for growth promotion and available by prescription only).

Antimicrobial resistance

Since 2011, we have observed an increasing number of human and agri-food isolates resistant to more than 5 antimicrobial classes.

Integrated antimicrobial use and resistance data

Chicken and people

Ceftiofur use in poultry

The poultry industry initiative to eliminate use of Category I antimicrobials (including the 3rd generation cephalosporin ceftiofur) for disease prevention appears to have had the desired effect to reduce antimicrobial resistance:

• There has been no reported ceftiofur use in broiler chickens since 2015
• There has been a reduction in resistance in both E. coli and Salmonella recovered from chickens on farm, at slaughter, and in chicken purchased at grocery stores
• Importantly, in Salmonella isolates recovered from people, resistance to the third generation cephalosporin ceftriaxone also declined

Campylobacter

There are currently regional differences in the prevalence of fluoroquinolone-resistant Campylobacter from chickens and chicken meat.

In 2017, resistance to ciprofloxacin was more commonly identified in human Campylobacter isolates and retail chicken from British Columbia compared to Alberta and Ontario.

Integrated findings and discussion

Integrated antimicrobial use

Antimicrobials are grouped into categories based on their importance to human medicine and the potential consequences of resistance to these drugs:

• Category I: Very high importance
  Examples: cephalosporins (3rd and 4th generation), carbapenems, fluoroquinolones
• Category II: High importance
  Examples: macrolides, penicillins
• Category III: Medium importance
  Examples: aminoglycosides, tetracyclines
• Category IV: Low importance
  Examples: ionophores, chemical coccidiostats

Similar to 2016, antimicrobials of low importance (Category IV, with the exception of flavophospholipids) were removed from the integrated AMU reporting. Data will be available in other CIPARS products.

Note: chemical coccidiostats are considered unclassified antimicrobials.

For reporting data on antimicrobials used in animals, we use different metrics or ways of reporting the information.

Why do we use different metrics?

• There are several different ways to collect, analyze, and report antimicrobial use data.
• No single approach is appropriate for all purposes. Certain metrics are better suited to looking at trends over time, while others may be more appropriate for comparing different regions or different host species, and others may be better for understanding relationships between use and resistance.

Comparing humans, animals, and crops

Canada is a major producer of food animals for domestic and international markets.

Figure 2 - Text Description

Human and animal population estimates with total kilograms of antimicrobials distributed and/or sold in 2017

Population	Estimated number	Ratio	Antimicrobials distributed and/or sold (kg)
Humans	36,540,268	1	249,026
Animals	768,334,311	21	948,615

Approximately 77% of antimicrobials distributed or sold^{Figure 3 footnote *} (when measured by kilograms of active ingredient) in 2017 were intended for production animals, 20% were for humans, 2% for crops and 1% for companion animals.

Figure 3 footnote *

When measured by kilograms of active ingredient.

Return to Figure 3 footnote * referrer

Figure 3 - Text Description

Proportion of total kilograms of antimicrobials distributed and/or sold in Canada in 2017, by sector

Antimicrobials distributed and/or sold	%
Companion animals	1%
Crops	2%
Human hospital purchases	3%
Human pharmacy dispensations	17%
Terrestrial production animals	76%
Marine and freshwater fish	1%
Total (across all sectors)	100%
Note: This graph is based on total kilograms distributed and is not adjusted for biomass. Animal distribution data currently does not account for quantities imported for own use, or as active pharmaceutical ingredients for further compounding; hence are underestimates of total quantities used.

Figure 4 - Text Description

The proportions of total kilograms of antimicrobial classes distributed or sold in 2017 in humans, production animals, and companion animals

Humans		Production Animals		Companion Animals
Antimicrobial Class	%	Antimicrobial Class	%	Antimicrobial Class	%
Beta-lactams/penicillins	51%	Tetracyclines	54%	Cephalosporins	34%
Cephalosporins	20%	Other antimicrobials	13%	Beta-lactams/penicillins	31%
Trimethoprim and sulfonamides	8%	Beta-lactams/penicillins	11%	Trimethoprim and sulfonamides	30%
Fluoroquinolones and quinolones	7%	Macrolides	10%	Lincosamides	2%
Macrolides	6%	Trimethoprim and sulfonamides	6%	Fluoroquinolones	1%

For both humans and animals, the β-lactams (penicillins) were one of the main antimicrobial classes distributed/sold on a per kg of antimicrobial basis.

Similar antimicrobials are licensed for use in humans and animals; however, some antimicrobial classes are sold or distributed more for use in humans than animals and vice-versa.

• Tetracyclines (Category III) are used predominantly in production animals
• The relative quantity of cephalosporins and Fluoroquinolones (Category I) intended for use in humans is higher compared to animals

Note: Cephalosporins are β-lactam antimicrobials, but we are displaying them separately for visualization purposes.

The total quantities of antimicrobials distributed for sale for use in production animals declined, both when measured in total kg and kg adjusted by biomass. These are the lowest reported values since surveillance began.

Figure 5 - Text Description

Figure 5. Quantities of antimicrobials distributed for use in animals

Year	Total (kg)	Total (mg/PCU European weights)	Total (mg/PCU Canadian weights)
2008	1,143,187	150	128
2009	1,141,213	160	137
2010	1,037,313	150	129
2011	1,121,715	168	145
2012Figure 5 footnote *	1,117,457	169	145
2013Figure 5 footnote *	1,118,097	170	145
2014Figure 5 footnote *	1,114,837	170	146
2015Figure 5 footnote *	1,187,136	183	157
2016Figure 5 footnote *	1,051,010	160	138
2017Figure 5 footnote *	934,873	141	122
Figure 5 footnote * Indicates years where data exclude antimicrobials sold for use in companion animals. Return to Figure 5 footnote * referrer

Figure 6 - Text Description

Quantities of antimicrobials used (mg/PCU) by Canada (2017) and countries participating in the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) network (2016)

European Countries	mg/PCU	Canada	Median of EU countries
Austria	46	141	57
Belgium	140	141	57
Bulgaria	155	141	57
Croatia	93	141	57
Cyprus	453	141	57
Czech Republic	61	141	57
Denmark	41	141	57
Estonia	64	141	57
Finland	19	141	57
France	72	141	57
Germany	89	141	57
Greece	64	141	57
Hungary	187	141	57
Iceland	5	141	57
Ireland	52	141	57
Italy	295	141	57
Latvia	30	141	57
Lithuania	38	141	57
Luxembourg	36	141	57
Netherlands	53	141	57
Norway	3	141	57
Poland	129	141	57
Portugal	208	141	57
Romania	85	141	57
Slovakia	50	141	57
Slovenia	30	141	57
Spain	363	141	57
Sweden	12	141	57
Switzerland	47	141	57
United Kingdom	45	141	57

Data Sources: Canadian Animal Health Institute (CAHI), European Surveillance of Veterinary Antimicrobial Consumption (ESVAC), Fisheries and Oceans Canada, Health Canada's Pest Management Regulatory Agency, human pharmacy and hospital data from IQVIA via the Canadian Antimicrobial Resistance Surveillance System, Statistics Canada, Agriculture and Agri-food Canada, and Equine Canada.

Comparing farm antimicrobial use data

Comparison of antimicrobial classes (kg of active ingredient)

There are important differences in the types and relative quantities of antimicrobials reported for use between food animal species, which is why we need ongoing surveillance across the food animal species.

Not shown: macrolides (1%), aminoglycosides (1%), lincosamides-aminocyclitols (<1%)

Not shown: pleuromutilins (1%)

Figure 7.1, 7.2, 7.3 - Text Description

The relative quantities of antimicrobial classes reported for use (mg/PCU) in animals in 2017

Broiler Chickens		Grower-Finisher Pigs		Turkeys
Antimicrobial Class	%	Antimicrobial Class	%	Antimicrobial Class	%
Bacitracins	61%	Tetracyclines	43%	Bacitracins	54%
Trimethoprim and sulfonamides	13%	Lincosamides	31%	Streptogramins	21%
Streptogramins	10%	Macrolides	12%	Trimethoprim and sulfonamides	12%
Penicillins	7%	Sulfonamides	7%	Macrolides	11%
Orthosomycins	6%	Penicillins	4%	Tetracyclines	1%
Tetracyclines	2%	Streptogramins	2%

Not shown: penicillins (<1%)

Temporal trends in antimicrobial use

Broiler chickens

Farm surveillance showed a reduction in antimicrobial use in 2017 compared with 2016 data in broiler chickens.

When we accounted for the number and weight of chickens, the top reported antimicrobials were:

1. Bacitracins
2. Trimethoprim
3. Streptogramins

When we accounted for the number of doses, the top reported antimicrobials were:

1. Bacitracins
2. Streptogramins
3. Orthosomycins

Figure 8 - Text Description

Temporal trends in mg/PCU in broiler chickens in Canada, 2013 to 2017

Year		2013	2014	2015	2016	2017
Number of flocks		99	143	136	136	138
Antimicrobial class
I	Fluoroquinolones	< 0.1	0	0	0	0
	Third-generation cephalosporins	< 0.1	< 0.1	0	0	0
II	Aminoglycosides	< 0.1	2	1	0.5	1
	Lincosamides-aminocyclitols	0.1	0.1	0.2	0.1	0.1
	Macrolides	7	11	7	3	1
	Penicillins	11	19	14	5	8
	Streptogramins	24	8	6	14	13
	Trimethoprim and sulfonamides	20	24	26	14	16
III	Bacitracins	75	79	74	82	77
	Tetracyclines	5	3	8	0	2
IV	Flavophospholipids	0.2	0	0.3	< 0.1	0.1
N/A	Orthosomycins	0	7	10	11	8
Total		142	153	147	130	127

Figure 9 - Text Description

Temporal trends in nDDDvetCA/1000 chicken-days at risk in broiler chickens, 2013 to 2017

Year		2013	2014	2015	2016	2017
Number of flocks		99	143	136	136	138
Antimicrobial class
I	Fluoroquinolones	0.04	0	0	0	0
	Third-generation cephalosporins	1	0.1	0	0	0
II	Aminoglycosides	0.0	2	2	1	1
	Lincosamides-aminocyclitols	0.5	0.5	1	0.5	0.5
	Macrolides	8	12	7	3	1
	Penicillins	34	33	47	25	31
	Streptogramins	237	83	63	139	128
	Trimethoprim and sulfonamides	85	85	89	50	61
III	Bacitracins	217	232	213	239	224
	Tetracyclines	9	4	15	1	4
N/A	Orthosomycins	0	72	98	117	79
Total		591	524	535	576	529

Grower-finisher pigs

A grower-finisher pig is a pig that is approximately 25 kilograms to market weight. Farm surveillance showed a reduction in antimicrobials used in feed in 2017 compared with 2016 data in grower-finisher pigs.

When we accounted for the number and weight of pigs, the top reported antimicrobials were:

1. Tetracycline
2. Lincosamides
3. Macrolides

When we accounted for the number of doses, the top reported antimicrobials were:

1. Lincosamides
2. Tetracyclines
3. Macrolides

Figure 10 - Text Description

Temporal trends in mg/PCU in grower-finisher pigs in Canada, 2009 to 2017

Year		2009	2010	2011	2012	2013	2014	2015	2016	2017
Number of herds		95	90	93	87	89	95	85	91	82
Antimicrobial class
II	Lincosamides	28.0	20.1	25.1	23.2	31.3	31.1	31.9	28.1	32.6
	Macrolides	35.9	43.7	44.2	43.3	36.8	33.2	27.3	27.0	12.5
	Penicillins	2.0	2.5	1.2	0.8	4.9	4.9	3.0	2.9	3.7
	Streptogramins	< 0.1	< 0.1	< 0.1	2.6	0.8	1.3	9.0	0.4	1.6
III	Aminogylcosides	0.2	0.1	0.4	0.0	0.0	0.6	0.4	0.0	0.0
	Bacitracins	0.0	0.8	0.0	0.0	0.8	0.0	0.0	0.0	0.0
	Pleuromutilins	< 0.1	1.7	1.8	2.1	3.2	6.0	4.7	1.9	1.5
	Sulfonamides	3.3	0.8	0.9	0.5	2.3	2.7	2.7	3.5	7.3
	Tetracyclines	87.5	73.0	83.6	83.1	66.3	84.7	97.0	51.6	44.9
IV	Flavophospholipids	0.1	0.1	< 0.1	0.1	< 0.1	< 0.1	0.1	0.2	0.2
Total	no data	157.1	142.9	157.2	155.7	146.4	164.6	176.3	115.5	104.3

Figure 11 - Text Description

Temporal trends in nDDDvetCA/1000 pig-days at risk in grower-finisher pigs, 2009 to 2017

Year		2009	2010	2011	2012	2013	2014	2015	2016	2017
Number of herds		95	90	93	87	89	95	85	91	82
Antimicrobial
II	Lincosamides	59	47	49	49	79	68	60	49	57
	Macrolides	104	122	129	122	103	92	76	78	37
	Penicillins	8	10	5	3	20	20	12	11	15
	Streptogramins	0.1	0.1	0.3	7	2	4	24	1	4
III	Aminocyclitols	2	1	4	0	0	6	4	0	0
	Bacitracins	0	2	0	0	2	0	0	0	0
	Pleuromutilins	0.1	3	4	4	6	11	9	4	0
	Sulfonamides	7	2	2	1	5	5	5	7	15
	Tetracyclines	87	64	73	72	58	72	82	44	38
Total		268	250	266	258	276	278	274	194	168

Turkeys

The overall reported antimicrobial use in turkeys was much lower than for broiler chickens and grower-finisher pigs in 2017.

When we accounted for the number and weight of turkeys, the top reported antimicrobials were:

1. Bacitracins
2. Streptogramins
3. Trimethoprim and sulfonamides

When we accounted for the number of doses, the top reported antimicrobials were:

1. Streptogramins
2. Bacitracins
3. Trimethoprim and sulfonamides

Figure 12 - Text Description

Temporal trends in mg/PCU in turkeys in Canada, 2016 to 2017

Year	2016	2017
Number of flocks	72	74
Antimicrobial class
Flavophospholipids	0	1
Tetracyclines	5	1
Bacitracins	37	33
Trimethoprim and sulfonamides	2	8
Streptogramins	12	13
Penicillins	1	1
Macrolides	3	7
Aminoglycosides	0.4	0.2
Fluoroquinolones	0	0
Total	60.6	63.1

Figure 13 - Text Description

Temporal trends in nDDDvetCA/1000 turkey-days at risk in turkeys, 2016 to 2017

Year	2016	2017
Number of flocks	72	74
Antimicrobial class
Tetracyclines	4	0
Bacitracins	43	38
Trimethoprim and sulfonamides	5	13
Streptogramins	48	52
Penicillins	2	1
Macrolides	1	3
Aminoglycosides	0	0
Fluoroquinolones	1	0
Total	103	108

Reasons for antimicrobial use

• In broiler chickens, turkeys and grower-finisher pigs, the predominant reason for administering antimicrobials in 2017 was for disease prevention
• In 2017, the overall reported antimicrobial use in broiler chickens and grower- finisher pigs declined

Figure 14 - Text Description

Quantity of antimicrobials used (mg/PCU) by reason for use; CIPARS Farm 2013 to 2017

Year	2013		2014		2015		2016			2017
Sector	G-F Swine	Br. Chicken	G-F Swine	Br. Chicken	G-F Swine	Br. Chicken	G-F Swine	Br. Chicken	Turkeys	G-F Swine	Br. Chicken	Turkeys
Number of Farms	89	99	95	143	85	136	91	136	72	82	138	74
Disease Treatment	23	28	26	42	16	31	4	14	3	4	18	6
Disease Prevention	85	101	88	106	90	115	77	116	58	54	109	56
Growth Promotion	38	13	50	5	70	1	35	0	0	46	1	1
Total	146	142	164	152	176	147	116	130	61	104	127	63

Swine data are for antimicrobial use in feed only; chicken and turkey data include all routes of administration.

Integrated antimicrobial resistance data

In this section, we highlight 2 resistance stories: highly drug resistant Salmonella and fluoroquinolone-resistant Campylobacter.

The number of highly drug resistant isolates are increasing

• In 2017, CIPARS tested for resistance to 7 antimicrobial classes
• While there is no international standard defining highly resistant isolates, CIPARS considers isolates which have resistance to 6 or more classes of antimicrobials to be highly drug resistant

Highly drug resistant Salmonella

• Between 2008 and 2016, there was a substantial increase in the number of highly resistant Salmonella isolates from agri-food and human sources; however, there was a decrease in 2017
• In 2017, 76 Salmonella isolates were identified as highly drug resistant from the following sources:

Figure 15 - Text Description

Number of Salmonella isolates resistant to 6 or more antimicrobial classes

Year	Cattle	Pigs	Chicken	Turkey	Human (non-typhoidal)
2008	0	0	0	0	7
2009	0	0	0	0	10
2010	0	0	0	0	8
2011	5	2	0	2	10
2012	7	0	0	3	8
2013	26	2	0	3	16
2014	32	7	0	0	12
2015	39	16	0	0	25
2016	52	21	0	0	32
2017	31	8	0	1	36

• In E. coli, one important difference is that highly resistant E. coli isolates were detected from chickens, in addition to other host species.

Fluoroquinolone resistance in Campylobacter

• Resistance to ciprofloxacin in Campylobacter from chicken(s) continued to vary over time and across regions, although the highest proportion of resistant isolates across all surveillance components continued to be from British Columbia
• Resistance to ciprofloxacin was more commonly identified in human isolates from British Columbia compared to Alberta and Ontario
• Despite the different trends in resistance to ciprofloxacin among Campylobacter isolates from different surveillance components and regions, there has been no reported fluoroquinolone use on sentinel broiler chicken farms since 2013

Figure 16 - Text Description

Ciprofloxacin resistance in Campylobacter isolates from chicken over time and between regions; CIPARS 2011 to 2017

Population	Province	Number of Isolates	Year	%
Retail Chicken	British Columbia	71	2011	13%
		73	2012	8%
		57	2013	26%
		43	2014	21%
		46	2015	41%
		65	2016	35%
		74	2017	32%
Abattoir Chicken		39	2011	18%
		47	2012	4%
		43	2013	28%
		46	2014	24%
		52	2015	40%
		44	2016	39%
		47	2017	43%
Farm Chicken		27	2013	41%
		26	2014	27%
		25	2015	24%
		31	2016	29%
		44	2017	36%
HumanTable 16 footnote *,Table 16 footnote **		222	2011	34%
		276	2012	38%
		232	2013	38%
		222	2014	45%
		Not applicable	2015	Not applicable
		Not applicable	2016	Not applicable
		28	2017	39%

Ciprofloxacin resistance in Campylobacter isolates from chicken over time and between regions; CIPARS 2011 to 2017 - Prairies

Population	Province	Number of Isolates	Year	%
Retail Chicken	Prairies	25	2011	4%
		40	2012	5%
		25	2013	4%
		67	2014	12%
		65	2015	9%
		16	2016	6%
		10	2017	30%
Abattoir Chicken		21	2011	5%
		33	2012	6%
		21	2013	0%
		36	2014	0%
		24	2015	0%
		20	2016	5%
		34	2017	15%
Farm Chicken		15	2013	0%
		11	2014	0%
		46	2015	2%
		28	2016	14%
		30	2017	0%
HumanTable 16 footnote *,Table 16 footnote **		not applicable	2011	not applicable
		not applicable	2012	not applicable
		not applicable	2013	not applicable
		not applicable	2014	not applicable
		not applicable	2015	not applicable
		29	2016	45%
		69	2017	31%

Ciprofloxacin resistance in Campylobacter isolates from chicken over time and between regions; CIPARS 2011 to 2017 - Ontario

Population	Province	Number of Isolates	Year	%
Retail Chicken	Ontario	71	2011	6%
		88	2012	16%
		84	2013	8%
		76	2014	12%
		39	2015	15%
		46	2016	15%
		29	2017	3%
Abattoir Chicken		29	2011	3%
		41	2012	15%
		43	2013	16%
		62	2014	13%
		42	2015	7%
		67	2016	7%
		40	2017	20%
Farm Chicken		20	2013	20%
		35	2014	6%
		36	2015	36%
		26	2016	0%
		36	2017	14%
HumanTable 16 footnote *,Table 16 footnote **		not applicable	2011	not applicable
		not applicable	2012	not applicable
		not applicable	2013	not applicable
		not applicable	2014	not applicable
		not applicable	2015	not applicable
		106	2016	22%
		18	2017	28%

Ciprofloxacin resistance in Campylobacter isolates from chicken over time and between regions; CIPARS 2011 to 2017 - Québec

Population	Province	Number of Isolates	Year	%
Retail Chicken	Québec	57	2011	0%
		79	2012	3%
		58	2013	4%
		54	2014	4%
		49	2015	2%
		49	2016	6%
		52	2017	6%
Abattoir Chicken		9	2011	0%
		23	2012	4%
		11	2013	0%
		12	2014	8%
		8	2015	25%
		17	2016	12%
		9	2017	11%
Farm Chicken		19	2013	5%
		21	2014	0%
		10	2015	0%
		8	2016	0%
		12	2017	0%
HumanTable 16 footnote *,Table 16 footnote **		not applicable	2011	not applicable
		not applicable	2012	not applicable
		not applicable	2013	not applicable
		not applicable	2014	not applicable
		not applicable	2015	not applicable
		not applicable	2016	not applicable
		not applicable	2017	not applicable

Integrated antimicrobial use and resistance data

Ceftriaxone resistance in non-typhoidal Salmonella and generic E. coli

Ceftriaxone is a Category I antimicrobial (very high importance to human medicine) that is used to treat a variety of human infections. They are the preferred option for the treatment of serious, potentially life-threatening human infections.

Although ceftriaxone is not used in animals, a similar drug (ceftiofur) is used to treat a range of animal infections. In most situations, if an organism is resistant to one of these drugs, it will also be resistant to the other.

Because Category I antimicrobials are those considered most important to human health, the poultry industry took steps to reduce their use. In mid-2014, the poultry industry implemented a national ban on the use of Category I antimicrobials for disease prevention purposes.

Subsequent data have shown no reported use of ceftiofur in sentinel broiler chicken flocks since 2015 as well as reduced resistance in both E. coli and Salmonella from chickens and chicken meat.

• Most ceftriaxone resistance in humans has been observed in isolates of Salmonella Heidelberg. Resistance to ceftriaxone in Salmonella Heidelberg isolates from humans decreased from 15% in 2016 to 12% in 2017
• We are seeing similar declines in ceftriaxone resistance in isolates from chicken at abattoir and on farm, and similar trends in ceftriaxone resistance in E. coli isolates

Figure 17 - Text Description

Reduction in reported use of ceftiofur on farm and changing resistance to ceftriaxone in non-typhoidal Salmonella and E. coli from humans and chicken sources between 2013 and 2017

Year	2013	2014	2015	2016	2017
Component	Isolates resistant to ceftriaxone
Retail chicken Salmonella	26%	21%	13%	7%	6%
Human non-typhoidal Salmonella	6%	6%	5%	4%	4%
Retail chicken E. coli	28%	19%	17%	9%	6%
Percentage of flocks reporting the use of ceftiofur
Broiler chicken flocks on farm	31%	6%	0%	0%	0%

The reduction in use of ceftiofur and associated reduction in ceftriaxone resistance in chickens and humans is a good example of a successful intervention to limit antimicrobial resistance that CIPARS continues to follow.

Glossary

Antimicrobial class	Antimicrobials are grouped into the same class if they have a common chemical structure and method to kill or stop the growth of bacteria. CIPARS uses the Clinical and Laboratory Standards Institute to define antimicrobial class.
Biomass and Population Correction Unit (PCU)	The PCU accounts for the size of the population, including the number and weight (biomass) of animals or people in the population. CIPARS adjusts (or corrects) for the "size" of populations to interpret antimicrobial use, consumption or sales data using methods reported by the European Surveillance of Veterinary Antimicrobial Consumption.
DDDvet	This is an acronym for the "Defined Daily Dose for animals". The amount of antimicrobials given during a treatment (dose) will vary depending on the antimicrobial, how the antimicrobial is given (e.g. by injection, through water or feed) and the population treated (cattle, chickens, pigs). CIPARS uses this metric to adjust for this variation and help interpret antimicrobial use data.
mg/PCU	An antimicrobial use metric that adjusts the quantity (milligram/mg) of antimicrobial used, consumed or distributed by the size of the population.
nDDDvet/1000 animal-days	An antimicrobial use metric that adjusts for both variation in the amount of antimicrobial given during a treatment (DDDvet), and the length of time that an animal or group of animals are treated to help interpret antimicrobial use data.

CIPARS will continue to monitor and communicate the impact of changing antimicrobial use practices on the occurrence of antimicrobial resistance to preserve the effectiveness of antimicrobials in animals and humans.

CIPARS analysts are working to develop new ways of identifying emerging issues and integrating data across various host species, bacterial species, and across regions.