A survey of hospitals in Ontario reveals that the incidence of carbapenemase-producing organisms (CPOs) doubled from 2022 to 2023, according to a report published last week by Public Health Ontario.
The survey, which was distributed to all public hospitals and microbiology labs in the province, found that 1,229 patients were either infected or colonized with a CPO in 2023, up from 560 patients in 2022. The overall rate of new patients with CPOs per 10,000 patients doubled, from 5.1 to 10.2. Of these new CPO patients, 98.2% were infected or colonized with Enterobacteriaceae organisms. The most commonly reported carbapenemase was New Delhi Metallo-beta-lactamase (55.2%), followed by Oxacillinase (26.0%) and Klebsiella pneumoniae carbapenemase (13.7%).
Data from labs also showed increasing resistance to third-generation cephalosporins among Escherichia coli (from 9.6% in 2017 to 12.8% in 2023) and Klebsiella pneumoniae (4.7% to 9.2%) isolates, as well as rising resistance to ciprofloxacin among E coli isolates. Resistance to ciprofloxacin among E coli isolates climbed to 22.3% in 2023, the highest resistance levels reported to date.
MRSA incidence declining
Other key findings include a 17.5% decrease in the number of new patients with methicillin-resistant Staphylococcus aureus (MRSA) isolated from any specimen site compared with 2022 and a decline in the Clostridioides difficile positivity rate (from 12.1% in 2022 to 10.1% in 2023). The incidence of vancomycin-resistant enterococci remained stable, and Candida auris incidence remained rare, with only three cases reported in 2023.
"The epidemiological data obtained from Ontario laboratories and hospital infection prevention and control programs helps in understanding the impact of AROs [antimicrobial-resistant organisms] and informs recommendations to prevent spread within our province," the report stated. "Continued and improved surveillance of AROs are necessary to understand the current landscape of resistance. Identifying regional variation in incidence of organisms can inform provincial and local decisions regarding appropriate application of infection control policies."