Rates of vancomycin-resistant enterococci bloodstream infections have remained relatively low in Canada. We recently observed an increase of 113% in these infections rates, which coincided with emergence of Enterococcus faecium pstS-null sequence type 1478. The proportion of this sequence type increased from 2.7% to 38.7% for all tested isolates from 2013–2018.

Vancomycin-resistant enterococci (VRE) can be associated with serious bacteraemia. The focus of this study was to characterize the molecular epidemiology of VRE from bacteraemia cases that were isolated from 1999 to 2009 as part of Canadian Nosocomial Infection Surveillance Program (CNISP) surveillance activities.From 1999 to 2009, enterococci were collected from across Canada in accordance with the CNISP VRE surveillance protocol. MICs were determined using broth microdilution. PCR was used to identify vanA, B, C, D, E, G and L genes. Genetic relatedness was examined using multilocus sequence typing (MLST).A total of 128 cases of bacteraemia were reported to CNISP from 1999 to 2009. In 2007, a significant increase in bacteraemia rates was observed in western and central Canada. Eighty-one of the 128 bacteraemia isolates were received for further characterization and were identified as Enterococcus faecium. The majority of isolates were from western Canada (60.5), followed by central (37.0) and eastern (2.5) Canada. Susceptibilities were as follows: daptomycin, linezolid, tigecycline and chloramphenicol, 100; quinupristin/dalfopristin, 96.3; high-level gentamicin, 71.6; tetracycline, 50.6; high-level streptomycin, 44.4; rifampicin, 21.0; nitrofurantoin, 11.1; clindamycin, 8.6; ciprofloxacin, levofloxacin and moxifloxacin, 1.2; and ampicillin, 0.0. vanA contributed to vancomycin resistance in 90.1 of isolates and vanB in 9.9. A total of 17 sequence types (STs) were observed. Beginning in 2006 there was a shift in ST from ST16, ST17, ST154 and ST80 to ST18, ST412, ST203 and ST584.The increase in bacteraemia observed since 2007 in western and central Canada appears to coincide with the shift of MLST STs. All VRE isolates remained susceptible to daptomycin, linezolid, chloramphenicol and tigecycline.

Background: Diabetic foot clinics have been reported as a source of acquisition of methicillin-resistant Staphylococcus aureus (MRSA). We undertook a 10-year review of patients infected or colonized with MRSA from a tertiary care hospital diabetic foot clinic and describe the epidemiology and genotypes of newly acquired MRSA in comparison with the community at large.Methods: All new MRSA cases from the diabetic foot clinic, the hospital, and the province were reviewed to identify and compare the 10-year trend in MRSA incidence. Pulsed-field gel electrophoresis using SmaI of all clinic isolates was performed, and standard genotypes were assigned to assess the genetic heterogeneity of MRSA in the clinic.Results: Analysis of trends revealed a low-potential, clinic-attributable incidence and a total clinic incidence that was comparable with regional and hospital MRSA rates. Strains recovered from clinic patients were genetically heterogeneous.Conclusion: Our 10-year analysis of trends in MRSA acquisition and MRSA genotypes data does not support significant transmission of MRSA in this clinic setting.

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Surveillance for vancomycin-resistant enterococci (VRE) in sentinel Canadian hospitals has been conducted since 1999. From 1999 to 2005, the rate of VRE detection increased from 0.37 to 1.32 cases per 1,000 patients admitted, and the rate of VRE infection increased from 0.02 to 0.05 cases per 1,000 patients admitted. Thirty-three percent of all patients with VRE detected that were reported during 1999-2005 were identified in 2005, with increases seen in all regions of Canada. Although the incidence rate of VRE carriage in Canada is increasing, it remains very low.