Article Figures & Tables
Figures
- Figure 1:
Antimicrobial use by indication for community-acquired infections. The values in the columns indicate the number of each type of antimicrobial prescribed for patients. Note: GI = gastrointestinal, IV = intravenous, PO = by mouth, UTI = urinary tract infection.
- Figure 2:
Antimicrobial use by indication for health care–acquired infection. The values in the columns indicate the number of each type of antimicrobial prescribed for patients. Note: CDAD = Clostridiodes difficile–associated diarrhea, IV = intravenous, PO = by mouth, SSI = surgical site infection, UTI = urinary tract infection.
- Figure 3:
The top 15 antimicrobials used for a therapeutic purpose.
- Figure 4:
Use of biomarkers to guide treatment. Note: CRP = C-reactive protein, PCT = procalcitonin.
Tables
Characteristic No. (%) of patients*
n = 13 272Patients Adult 12438 (93.7) Age, yr, mean ± SD 64.0 ± 17.9 Sex, male 6816 (54.8) Pediatric 427 (3.2) Age, yr, mean ± SD 7.6 ± 7.6 Sex, male 253 (59.0) Neonate 407 (3.1) Age, yr Not recorded Sex, male 294 (72.2) Hospitals Type Primary† 1325 (10.0) Secondary‡ 3947 (29.7) Tertiary and specialized§ 8000 (60.3) Region Western¶ 3862 (29.1) Central** 6440 (48.5) Atlantic†† 2970 (22.4) Note: SD = standard deviation.
↵* Unless indicated otherwise.
↵† Often referred to as a district hospital or first-level referral. It usually corresponds to a general hospital without teaching functions.
↵‡ Often referred to as provincial hospital. It is a hospital highly differentiated by function with 5–10 clinical specialties, which takes some referrals from other (primary) hospitals. It often corresponds to a general hospital with teaching functions.
↵§ Often referred to as a central or regional hospital. It is a hospital with highly specialized staff and technical equipment (e.g., hematology, transplantation, cardiothoracic surgery, neurosurgery and specialized imaging units and an intensive care unit). Clinical services are highly differentiated by function.
↵¶ British Columbia, Alberta, Saskatchewan and Manitoba.
↵** Ontario and Quebec.
↵†† Newfoundland and Labrador, Prince Edward Island, Nova Scotia and New Brunswick.
- Table 2:
Overall antimicrobial prevalence and use by hospital type, hospital location and ward type
Characteristic No. of patients No. (%) of patients receiving antimicrobials No. of antimicrobials received No. (%) of antimicrobials received; indication Therapeutic use Medical prophylaxis Surgical prophylaxis Other or unknown Total 13 272 4447 (33.5) 6525 4832 (74.1) 825 (12.6) 578 (8.9) 290 (4.4) Hospital type Primary 1325 388 (29.3) 518 415 (80.1) 33 (6.4) 38 (7.3) 32 (6.2) Secondary 3947 1225 (31.0) 1635 1316 (80.5) 101 (6.2) 156 (9.5) 62 (3.8) Tertiary and specialized 8000 2834 (35.4) 4372 3101(70.9) 691 (15.8) 384 (8.8) 196 (4.5) Region West 3862 1424 (36.9) 2092 1572 (75.1) 241 (11.5) 198 (9.5) 81 (3.9) Central 6440 2240 (34.8) 3372 2462 (73.0) 467 (13.8) 293 (9.7) 150 (4.4) Atlantic 2970 783 (26.4) 1061 798 (75.2) 117 (11.0) 87 (8.2) 59 (5.6) Adult wards All wards 12 438 4230 (34.0) 6171 4610 (74.7) 749 (12.1) 567 (9.2) 245 (4.0) Adult medical ward 7686 2031 (26.4) 2753 2319 (84.2) 227 (8.2) 86 (3.1) 121 (4.4) Hematology–oncology adult medical ward 420 205 (48.8) 387 199 (51.4) 175 (45.2) 4 (1.0) 9 (2.3) Transplant adult medical ward 142 113 (79.6) 305 123 (40.3) 178 (58.4) 0 4 (1.3) Pneumology adult medical ward 159 91 (57.2) 196 156 (79.6) 37 (18.9) 1 (0.5) 2 (1.0) Adult surgical ward 3083 1318 (42.8) 1755 1205 (68.7) 73 (4.2) 403 (23.0) 74 (4.2) Adult intensive care unit 948 472 (49.8) 775 608 (78.5) 59 (7.6) 73 (9.4) 35 (4.5) Pediatric and neonatal wards All wards 834 217 (26.0) 354 222 (62.7) 76 (21.5) 11 (3.1) 45 (12.7) Pediatric medical ward 307 81 (26.4) 115 90 (78.3) 7 (6.1) 3 (2.6) 15 (13.0) General neonatal medical ward 151 7 (4.6) 14 12 (87.5) 2 (14.3) 0 0 Hematology–oncology pediatric medical ward 25 21 (84.0) 46 17 (37.0) 24 (52.2) 0 5 (10.9) Pediatric surgical ward 57 24 (42.1) 32 20 (62.5) 4 (12.5) 5 (15.6) 3 (9.4) Pediatric intensive care unit 38 21 (55.3) 39 24 (61.5) 9 (23.1) 0 6 (15.4) Neonatal intensive care unit 256 63 (24.6) 108 59 (54.6) 30 (27.8) 3 (2.8) 16 (14.8) - Table 3:
Documentation of indications, planned duration or review, and adherence to local guidelines, by region
Indicator Region; no. (%) of antimicrobial prescriptions* Total West Central Atlantic No. of hospitals 47 11 22 14 No. of antimicrobials received 6525 2092 3372 1061 No. of antimicrobials for therapeutic use 4832 1572 2462 798 Targeted treatment 1906/4832 (39.4) 716/1572 (45.5) 936/2462 (38.0) 254/798 (31.8) Reasons in notes 5699/6525 (87.3) 1899/2092 (90.8) 2922/3372 (86.7) 878/1061 (82.8) Stop or review date documented 4106/6525 (62.9) 1357/2092 (64.9) 2095/3372 (62.1) 564/1061 (53.2) Guidelines available 4697/6525 (72.0) 1746/2092 (83.5) 2491/3372 (73.9) 460/1061 (43.4) Compliant with guidelines 3928/4697 (83.6) 1474/1746 (84.4) 2125/2491 (85.3) 329/460 (71.5) No guidelines available 1604/6525 (24.6) 281/2092 (13.4) 763/3372 (22.6) 560/1061 (52.8) No information on guidelines because indication is unknown 224/6525 (3.5) 65/2092 (3.2) 118/3372 (3.5) 41/1061 (3.9) ↵* Unless indicated otherwise.
Multidrug-resistant organism Region; no. (%) of patients treated for multidrug-resistant organisms* Total
n = 1470Region West
n = 535Central
n = 716Atlantic
n = 219MRSA 82 (5.6) 51 (9.5) 30 (4.2) 1 (0.5) MRCoNS 33 (2.2) 12 (2.2) 18 (2.5) 3 (1.4) VRE 10 (0.7) 4 (0.7) 6 (0.8) 0 ESBL-producing Enterobacteriaceae 41 (2.8) 22 (4.1) 11 (1.5) 8 (3.7) 3-ceph 60 (4.1) 26 (4.9) 19 (2.7) 15 (6.8) CRE 5 (0.3) 5 (0.9) 0 0 ESBL-NF 22 (1.5) 12 (2.2) 9 (1.3) 1 (0.5) CR-NF 25 (1.7) 9 (1.7) 13 (1.8) 3 (1.4) Other multidrug-resistant organism 75 (5.1) 45 (8.4) 24 (3.4) 6 (2.7) Note: 3-ceph = third-generation cephalosporin-resistant Enterobacterales, CRE = carbapenem-resistant Enterobacterales, CR-NF = carbapenem-resistant nonfermenter Gram-negative bacilli, ESBL = extended-spectrum β-lactamase, ESBL-NF = ESBL-producing nonfermenter gram-negative bacilli, MRCoNS = methicillin-resistant coagulase-negative staphylococci, MRSA = methicillin-resistant Staphylococcus aureus, VRE = vancomycin-resistant enterococci.
↵* The denominator for the percentages in this table is the number of patients receiving antimicrobials for targeted use.
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