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Shifting Epidemiology of Carbapenemase-Producing Organisms: Time Series Analysis of the Provincial Surveillance Program in British Columbia, Canada from 2014-2023
32 Pages Posted: 29 Oct 2024
More...Abstract
Background: Carbapenemase-producing organisms (CPO) cause life-threatening multidrug resistant bacterial infections in healthcare settings. The epidemiology of CPO cases remains understudied, making surveillance, ascertainment of risk, and prevention difficult. We report upon CPO surveillance in British Columbia, Canada.Methods: Surveillance was performed from August 1st, 2014, to May 30th, 2023. Autoregressive integrated moving average and segmented linear regression models were used to describe trends in monthly case counts, estimate the number of travel-associated cases, and measure the impact of COVID-19 pandemic travel restrictions.Findings: Analytic data included 1,035 CPO cases. On average, monthly counts and yearly incidence of CPO cases increased over time. Cumulative cases of persons who traveled (n = 687) were positively associated with colonization (n = 601, P < 0·001), presence of New Delhi metallo-β-lactamase (NDM) (n = 453, P < 0·001) and older age (> 70 years) (P = 0·014). Carbapenemase genotypes differed by one-year, self-reported travel history. Some genotypes were associated with no-travel suggesting potential local acquisition (P < 0·001). Non-travel associated CPO cases have increased over time; no difference was estimated between the number of non-travel and travel-related cases per month since 2020. COVID-19 travel restrictions interrupted CPO case detection for one year (2020-2021), the decrease was not sustained as the incidence of CPO cases increased in 2022-2023 (IRR= 2·68, 95%CI: 2·07-3·01).Interpretation: The epidemiology of CPO has changed in British Columbia, Canada a low prevalence setting, over time. We recommend a greater focus on understanding and controlling non-travel related transmission post the COVID-19 pandemic.
Keywords: carbapenemase-producing organisms, New Delhi metallo-β-lactamase, klebsiella pneumoniae carbapenemase, oxacillinase-type beta-lactamase, surveillance, time series, COVID-19, Epidemiology, travel history, antimicrobial resistance
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