Carbapenem-resistant Gram-negative bacilli in Canada 2009-10: results from the Canadian Nosocomial Infection Surveillance Program (CNISP).

OBJECTIVES: To investigate the occurrence and molecular mechanisms associated with carbapenemases in carbapenem-resistant Gram-negative isolates from Canadian cases. METHODS: Twenty hospital sites across Canada submitted isolates for a 1 year period starting 1 September 2009. All Enterobacteriaceae with MICs ≥ 2 mg/L and Acinetobacter baumannii and Pseudomonas aeruginosa with MICs ≥ 16 mg/L of carbapenems were submitted to the National Microbiology Laboratory (NML) where carbapenem MICs were confirmed by Etest and isolates were characterized by PCR for carbapenemase genes, antimicrobial susceptibilities, PFGE and plasmid isolation. RESULTS: A total of 444 isolates (298 P. aeruginosa, 134 Enterobacteriaceae and 12 A. baumannii) were submitted to the NML of which 274 (61.7%; 206 P. aeruginosa, 59 Enterobacteriaceae and 9 A. baumannii) met the inclusion criteria as determined by Etest. Carbapenemase genes were identified in 30 isolates: bla(GES-5) (n = 3; P. aeruginosa), bla(KPC-3) (n = 7; Enterobacteriaceae), bla(NDM-1) (n = 2; Enterobacteriaceae), bla(VIM-2) and bla(VIM-4) (n = 8; P. aeruginosa) bla(SME-2) (n = 1; Enterobacteriaceae) and bla(OXA-23) (n = m9; A. baumannii). PFGE identified a cluster in each of Enterobacteriaceae, P. aeruginosa and A. baumannii corresponding to isolates harbouring carbapenemase genes. Three KPC plasmid patterns (IncN and FllA) were identified where indistinguishable plasmid patterns were identified in unrelated clinical isolates. CONCLUSIONS: Carbapenemases were rare at the time of this study. Dissemination of carbapenemases was due to both dominant clones and common plasmid backbones.

Geographical and temporal aspects of an outbreak of off-flavours in bulk-tank milk in Prince Edward Island, Canada.

The geographical and temporal dynamics of the outbreak of off-flavours in bulk-tank milk that occurred between September 2000 and June 2002 in Prince Edward Island (PEI) dairy herds were described using spatial, temporal and space-time scan statistics. Results suggested clustering both in time and space. We found one primary cluster (six case herds, feed off-flavour, October 2000 to January 2001) and two secondary clusters formed of feed (5 case herds, October 2000 to January 2001)) and rancid (five case herds, December 2000 to March 2001) off-flavours, respectively. The relative risk (RR) for producing off-flavoured milk was similar for these three clusters (RR=6.4).

Risk factors for milk off-flavours in dairy herds from Prince Edward Island, Canada.

A sudden increase in the incidence of milk off-flavours in bulk tank milk from Prince Edward Island (Canada) dairy farms in the late 1990s prompted an investigation of potential herd-level risk factors. A prospective case-control study was conducted from 2000 to 2002. Data on herd management were obtained by questionnaire and field investigation from all the 62 identified off-flavour positive farms (cases) and 62 loosely matched (for data-collection convenience) off-flavour negative farms (controls). Forty-three of the 62 cases (69%) of milk off-flavours identified during the study period were classified as "transmitted" (feed) off-flavours, and 9 (15%), 6 (10%), and 4 (6%) as "rancid", "oxidized" and "malty" off-flavours, respectively. Given this evidence and the relatively low incidence of other flavour defects in milk, only transmitted-flavour cases were considered in the analyses of risk factors. Poor air quality in the lactating cows' barn (OR = 40.8), using baled silage as the main forage (OR = 10.6), as well as feeding roughage before milking (OR = 253.3) or as a free choice (OR = 3.2) all were significantly (P < 0.05) associated with the incidence of transmitted flavours in bulk-tank milk. Clipping the hair on the cows' udder (OR = 0.07) and changing the bedding material more than once a day (OR = 0.12) were protective. The finding about feeding baled silage before milking has raised hypotheses about silage composition (in particular the off-flavour compounds or their precursors) and also about the process of silage making itself.

A summary of the Transfusion Error Surveillance System: 2008 - 2011.

BACKGROUND: Although Canada has one of the safest blood systems in the world, transfusion errors can occur at any time from the moment of collection through to the transfusion of blood and blood products. The Transfusion Error Surveillance System (TESS) was initiated by the Public Health Agency of Canada (the Agency) to monitor transfusion-related errors occurring at any point in the transfusion chain. OBJECTIVE: To offer an analysis of the TESS data reported from 2008 to 2011. METHODS: Between 2008 and 2011, 12 to 15 hospitals from four provinces participated in the TESS. Reports on all transfusion-related errors were sent electronically on a quarterly basis to the Agency where they were consolidated, cleaned, validated and analyzed. Different types of transfusion errors were categorized by time of discovery (pre- or post-transfusion) and their potential impact on the patient's health. The occurrence rates of different types of errors were calculated using corresponding denominator data. Results were grouped by the transfusion capacity of reporting hospitals. RESULTS: Between 2008 and 2011, a total of 34,088 transfusion-related errors were reported. Of these, 33,622 (98.6%) were detected prior to transfusion. The most commonly reported were errors related to the collection (40.1%) and handling (10.4%) of blood samples. Of the remaining 466 (1.4%) that were detected after transfusion, 66 were of high potential severity and 16 of them resulted in adverse reactions in recipients. Inappropriate / incorrect / no product order accounted for over 56% (n=9) of these errors and the most common adverse reaction was transfusion-associated circulatory overload which occurred in eight (50%) of the patients that developed adverse reactions. CONCLUSION: The TESS data from 2008 to 2011 demonstrates that blood transfusions are both safe and efficient in Canadian hospitals participating in the surveillance and also highlights the most common and most harmful errors that may be targeted for corrective actions.

A summary of the Transfusion Transmitted Injuries Surveillance System: 2006 - 2012.

BACKGROUND: The Transfusion Transmitted Injuries Surveillance System (TTISS) is a pan-Canadian surveillance system established by the Public Health Agency of Canada (the Agency) in partnership with the provinces and territories to capture non-nominal data on adverse transfusion reactions in Canadian hospitals providing transfusion services with the overarching goal of improving patient safety. OBJECTIVE: To summarize transfusion-related adverse reactions reported to the TTISS between 2006 and 2012. METHODS: Hospitals from 10 provinces and two territories participated in the TTISS by collecting and submitting data on all transfusion-related reactions or injuries to the provincial / territorial blood coordinating offices. This data was sent to the Agency where it was consolidated, cleaned, validated and analyzed by type of reactions or outcome. Corresponding rates were also calculated using the total number of units of blood components transfused as a denominator. RESULTS: From 2006 to 2012, a total of 3,957 adverse reactions were reported to the TTISS, excluding minor allergic reactions. Of these, 2,920 (73.8%) were related to transfusion of blood components and 1,036 (26.2%) were from the transfusion of blood products. Among reactions related to the transfusion of blood components, the most common were: transfusion-associated circulatory overload (n = 1,242, 42.5%), severe allergic / anaphylactic / anaphylactoid reactions (n=411; 14.1%) and hypotensive reactions (n=298; 10.2%). Among those related to transfusion of blood products, close to one-half were intravenous immunoglobulin (IVIG) headache (n=295; 28.5%) or delayed hemolytic reaction (n=175; 16.9%). Death definitely attributable to transfusion was extremely rare: only one case diagnosed with transfusion-related acute lung injury was identified between 2006 and 2012. CONCLUSION: The majority of reactions attributable to transfusion resulted in minor or no sequelae. Strengthening the TTISS will improve the monitoring of adverse transfusion reactions which is one of the key components of an overall patient safety strategy. Current initiatives to improve data quality include the development of transfusion-associated circulatory overload / transfusion-related acute lung injury recognition algorithm and the collection of appropriate denominators for the calculation of the rates of adverse reactions from the transfusion of blood products.