ARO Prevalence Study
Background
The emergence of antibiotic-resistant organisms (AROs) in health care institutions is a major public health
concern. Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant enterococci (VRE), and
Clostridium difficile are AROs that cause life-threatening infections in hospitalized patients. Epidemiological
studies, such as prevalence surveys, provide important information about the burden of disease and risk factors
associated with these organisms. This information is critical in order to develop effective strategies to control
the spread of these infections in hospitals. There are currently no prevalence data available for these antibioticresistant
organisms in Canadian healthcare facilities.
Objectives:
Primary Study Objectives
- To determine the prevalence of MRSA and VRE colonization and infection among adults hospitalized in
Canadian hospitals
- To determine the prevalence of C. difficile infection among adults hospitalized in Canadian hospitals
Secondary Study Objectives
- To describe demographic and select clinical/epidemiologic features of patients with prevalent MRSA,
VRE, and C. difficile infection in Canadian hospitals
- To determine institutional characteristics associated with MRSA, VRE, and C. difficile infection rates
Methods:
All 406 acute-care hospitals in Canada with at least 50 inpatient beds will be approached in the spring of
2010,and asked to participate. A one-day point-prevalence survey will be conducted in participating Canadian
hospitals on a single weekday in November 2010 (each institution will select a single day from within a two
week period). Adult patients (>17 yrs) admitted to the hospital at midnight on that day will be included. Using
standard definitions, ICPs or their designates will identify all those known to be colonized or infected with
MRSA or VRE, and all those known to have C. difficile infection, on the day of the survey, and complete a
short data collection form (it is anticipated that each hospital will be submitting 2-4 forms per 100 occupied
beds). Data will be anonymized, then forms either mailed to the central study office, or entered into a secure
website. Data will be analyzed centrally.
Importance:
AROs lead to excess morbidity and mortality, outbreaks, increased lengths of hospital stay and bed-blocking in
healthcare facilities. The treatment and prevention of these infections are associated with significant increased
direct and indirect costs to Canadian hospitals and society at-large. In the United States, cost estimates for
managing antimicrobial resistance were estimated to be between $4 billion and $10 billion per year. Although
the Canadian Nosocomial Infection Surveillance Program (CNISP) has provided valuable information, the
surveillance involves a relatively small number of healthcare facilities which are primarily tertiary-care teaching
hospitals. Moreover, CNISP surveillance has provided important incidence data, and has performed two
prevalence surveys, although antimicrobial resistant organisms were not a focus of either survey. A pointprevalence
survey including all possible Canadian hospitals, when combined with existing CNISP data, and
data from other provincial and regional surveillance systems, will assist public health officials and acute care
hospitals in priority setting and future resource allocation, site specific benchmarking, and infection control
planning.
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