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An Assessment of Antimicrobial Resistant Disease Threats in Canada

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  • Michael J Garner
  • Carolee Carson
  • Erika J Lingohr
  • Aamir Fazil
  • Victoria L Edge
  • Jan Trumble Waddell

Abstract

Background: Antimicrobial resistance (AMR) of infectious agents is a growing concern for public health organizations. Given the complexity of this issue and how widespread the problem has become, resources are often insufficient to address all concerns, thus prioritization of AMR pathogens is essential for the optimal allocation of risk management attention. Since the epidemiology of AMR pathogens differs between countries, country-specific assessments are important for the determination of national priorities. Objective: To develop a systematic and transparent approach to AMR risk prioritization in Canada. Methods: Relevant AMR pathogens in Canada were selected through a transparent multi-step consensus process (n=32). Each pathogen was assessed using ten criteria: incidence, mortality, case-fatality, communicability, treatability, clinical impact, public/political attention, ten-year projection of incidence, economic impact, and preventability. For each pathogen, each criterion was assigned a numerical score of 0, 1, or 2, and multiplied by criteria-specific weighting determined through researcher consensus of importance. The scores for each AMR pathogen were summed and ranked by total score, where a higher score indicated greater importance. A sensitivity analysis was conducted to determine the effects of changing the criteria-specific weights. Results: The AMR pathogen with the highest total weighted score was extended spectrum B-lactamase-producing (ESBL) Enterobacteriaceae (score=77). When grouped by percentile, ESBL Enterobacteriaceae, Clostridium difficile, carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus were in the 80-100th percentile. Conclusion: This assessment provides useful information for prioritising public health strategies regarding AMR resistance at the national level in Canada. As the AMR environment and challenges change over time and space, this systematic and transparent approach can be adapted for use by other stakeholders domestically and internationally. Given the complexity of influences, resource availability and multiple stakeholders, regular consideration of AMR activities in the public health realm is essential for appropriate and responsible prioritisation of risk management that optimises the health and security of the population.

Suggested Citation

  • Michael J Garner & Carolee Carson & Erika J Lingohr & Aamir Fazil & Victoria L Edge & Jan Trumble Waddell, 2015. "An Assessment of Antimicrobial Resistant Disease Threats in Canada," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-11, April.
    • Handle: RePEc:plo:pone00:0125155
    DOI: 10.1371/journal.pone.0125155
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    References listed on IDEAS

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    1. Victoria Ng & Jan M Sargeant, 2013. "A Quantitative Approach to the Prioritization of Zoonotic Diseases in North America: A Health Professionals’ Perspective," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-19, August.
    2. Juliana Martins Ruzante & Valerie J. Davidson & Julie Caswell & Aamir Fazil & John A. L. Cranfield & Spencer J. Henson & Sven M. Anders & Claudia Schmidt & Jeffrey M. Farber, 2010. "A Multifactorial Risk Prioritization Framework for Foodborne Pathogens," Risk Analysis, John Wiley & Sons, vol. 30(5), pages 724-742, May.
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