Canadian Antimicrobial Resistance Surveillance System

Canadian Antimicrobial Resistance Surveillance System
Name	Canadian Antimicrobial Resistance Surveillance System
Abbrev	CARSS
Formation	2009
Purpose	Antimicrobial resistance surveillance
Headquarters	Ottawa, Ontario
Region served	Canada
Parent organization	Public Health Agency of Canada

Canadian Antimicrobial Resistance Surveillance System is a national surveillance network that monitors bacterial antimicrobial resistance and antimicrobial use across human and animal sectors in Canada. It integrates laboratory data, clinical reports, and stewardship indicators to inform policy for public health agencies such as the Public Health Agency of Canada, the Canadian Food Inspection Agency, and provincial ministries like Ontario Ministry of Health and Alberta Health Services. CARSS collaborates with international actors including the World Health Organization, the Food and Agriculture Organization, and the World Organisation for Animal Health.

Overview

CARSS consolidates data on bacterial pathogens and resistance determinants from clinical laboratories, sentinel sites, and administrative databases to provide national estimates and trends. Its reporting supports decision-making by stakeholders including the Health Canada regulatory framework, hospital networks like Toronto General Hospital, regional public health units such as Vancouver Coastal Health, and academic centres like the University of Toronto and McGill University. The system aligns with global initiatives from the Global Antimicrobial Resistance Surveillance System and regional collaborations involving the Pan American Health Organization and the European Centre for Disease Prevention and Control.

History and development

Established in response to rising awareness after national reviews and expert panels including commissions led by figures associated with institutions such as the Canadian Institute for Health Information and the Canadian Nosocomial Infection Surveillance Program, CARSS built on legacy projects from provincial programs in Quebec and British Columbia. Its development involved partnerships with federal agencies like the Public Health Agency of Canada and research networks at centres including the National Microbiology Laboratory and the Institut national de santé publique du Québec. Over time CARSS incorporated methodologies promoted by global bodies such as the World Health Organization and standards from the International Organization for Standardization.

Surveillance methods and data sources

CARSS synthesizes laboratory antimicrobial susceptibility results reported by sentinel laboratories, hospital diagnostic services like Sunnybrook Health Sciences Centre, and provincial reference laboratories such as the Alberta Precision Laboratories. It integrates administrative datasets from agencies like the Canadian Institute for Health Information and prescription databases that involve stakeholders such as Pharmacy Guilds and provincial drug plans including Ontario Drug Benefit Program. Molecular surveillance leverages sequencing capacity at the National Microbiology Laboratory and university centres like University of British Columbia to detect resistance genes and clones linked to lineages characterized in studies by institutions such as Mount Sinai Hospital (Toronto).

Governance and participating organizations

CARSS is coordinated administratively by the Public Health Agency of Canada and governed through technical committees comprising representatives from provincial ministries, territorial health departments like Yukon Department of Health and Social Services, and federal partners including the Canadian Food Inspection Agency and Health Canada. Participating laboratories include provincial public health labs such as the British Columbia Centre for Disease Control and academic hospital labs at institutions like McMaster University, with input from professional bodies including the Canadian Medical Association and the Canadian Veterinary Medical Association. International liaison occurs with the World Health Organization and bilateral collaborators such as the United States Centers for Disease Control and Prevention.

Key findings and trends

CARSS reports have documented rising resistance in priority pathogens including Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa, with notable increases in extended-spectrum beta-lactamase–producing isolates and carbapenem-resistant Enterobacterales detected in data from clinical networks tied to hospitals like Ottawa Hospital and Jewish General Hospital. Trends indicate geographic variation across provinces such as higher rates reported in surveillance from Manitoba and Saskatchewan compared with some Atlantic provinces, and associations with antimicrobial prescribing patterns observed through links to pharmacy claims in programs like Nova Scotia Pharmacare. Molecular surveillance has highlighted dissemination of clones related to international lineages described in publications from entities such as the European Centre for Disease Prevention and Control and sequence databases curated by the National Center for Biotechnology Information.

Public health actions and policies

Findings from CARSS inform stewardship programs in acute care settings such as those implemented at St. Michael's Hospital and in long-term care regulations overseen by provincial authorities like Québec Health Insurance Plan. Data have supported regulatory decisions by Health Canada on antimicrobial approvals and veterinary use guidance by the Canadian Food Inspection Agency, and contributed to national action planning consistent with the Canadian Antimicrobial Resistance Framework and international commitments endorsed at assemblies of the World Health Assembly. CARSS outputs are used by guideline bodies including the Infectious Diseases Society of America–affiliated Canadian groups and hospital infection prevention teams.

Challenges and future directions

CARSS faces challenges in harmonizing laboratory methods across diverse participants including provincial labs such as Saskatchewan Disease Control Laboratory and in integrating human, animal, and environmental data from sectors involving stakeholders like the Canadian Veterinary Medical Association and agricultural agencies. Future directions emphasize expansion of genomic surveillance through partnerships with sequencing centres at institutions like Simon Fraser University, improved timeliness by enhancing electronic reporting interoperable with systems such as those used by Alberta Health Services, and strengthening One Health linkages with the Food and Agriculture Organization and marine/environmental monitoring projects. Priorities include addressing data gaps in territories such as Nunavut and advancing policy translation via collaboration with ministers such as those in Health Canada and provincial health ministries.

Category:Health surveillance in Canada