Antimicrobial resistance patterns among urinary isolates from long-term care residents in Canada: findings from an AMRNet pilot
- 1National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, MB, Canada
Abstract
Background: Antimicrobial resistance is a growing concern in long-term care facilities (LTCs), where residents are often older, have chronic health conditions, and are frequently prescribed antimicrobials. Historically, antimicrobial resistance data from Canadian LTCs have been limited. This study explores the use of lab-based surveillance data from the Public Health Agency of Canada's AMRNet program to describe antimicrobial resistance in LTCs. Methods: Antimicrobial susceptibility data for clinical bacterial specimens were submitted from public and private laboratories across Canada. Where feasible, LTC patients were identified by submitting jurisdictions. Data on urinary isolates from identified LTC patients were analysed using the first isolate per patient per species per calendar year. The data were described by distribution of age group, sex, species and antimicrobial susceptibility. Antimicrobials were classified by the World Health Organization's 'Access, Watch and Reserve' (AWaRe) framework and a weighted-incidence syndromic combination antibiogram was constructed. As part of AMRNet program development, in some jurisdictions, only certain specimen types or organisms were submitted. Not all jurisdictions participated every year. Due to privacy precautions, some values rely on estimations. Results: From 2016-2024, AMRNet received data on 216,524 isolates from five provinces (BC, NL, ON, PEI, SK). Most isolates (98%) were from patients aged >=60, with those >=80 years representing 80%; females predominated across all age groups. Urine represented >99% of submitted data. The most common organisms identified from urinary isolates were Escherichia coli (51%), Klebsiella pneumoniae (14%) and Proteus mirabilis (12%). Non susceptibility varied across organisms: E. coli demonstrated higher non-susceptibility to several commonly used agents including fluoroquinolones (44%) and third generation cephalosporins (18%) while K. pneumoniae displayed high non-susceptibility to nitrofurantoin (56%). Among P. mirabilis, 26% were non susceptible to ciprofloxacin. Aminoglycoside and carbapenem resistance were low. When antimicrobials were grouped by WHO AWaRe categories, more than half of E. coli isolates were non-susceptible to at least one Watch antimicrobial. Interpretation: AMRNet lab-based surveillance data can help describe national AMR patterns among LTC residents. Although limitations exist and identifying LTC patients in lab-based datasets can be challenging in some jurisdictions, these data provide a feasible and cost-effective means of tracking national resistance trends among an at-risk population.
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BibTeX
@misc{yadav2026antimicrobial,
title = {{Antimicrobial resistance patterns among urinary isolates from long-term care residents in Canada: findings from an AMRNet pilot}},
author = {C. Yadav and K. Amaratunga and A. Bharat and K. Afra and K. A. Brown and C. Chato and N. Daneman and B. Langford and G. McDonald and X. Ding and C. Norgaard and M. Faires and L. Hoang and P. Kibsey and E. Lee and A. Mak and J. Minion and P. Daley and W. Rudnick},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.29.26366712},
url = {https://www.medrxiv.org/content/10.64898/2026.10.29.26366712v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Antimicrobial resistance patterns among urinary isolates from long-term care residents in Canada: findings from an AMRNet pilot
AU - C. Yadav
AU - K. Amaratunga
AU - A. Bharat
AU - K. Afra
AU - K. A. Brown
AU - C. Chato
AU - N. Daneman
AU - B. Langford
AU - G. McDonald
AU - X. Ding
AU - C. Norgaard
AU - M. Faires
AU - L. Hoang
AU - P. Kibsey
AU - E. Lee
AU - A. Mak
AU - J. Minion
AU - P. Daley
AU - W. Rudnick
PY - 2026
DA - 2026/10/29
PB - medRxiv
DO - 10.64898/2026.10.29.26366712
UR - https://www.medrxiv.org/content/10.64898/2026.10.29.26366712v1
AB - Background: Antimicrobial resistance is a growing concern in long-term care facilities (LTCs), where residents are often older, have chronic health conditions, and are frequently prescribed antimicrobials. Historically, antimicrobial resistance data from Canadian LTCs have been limited. This study explores the use of lab-based surveillance data from the Public Health Agency of Canada's AMRNet program to describe antimicrobial resistance in LTCs. Methods: Antimicrobial susceptibility data for clinical bacterial specimens were submitted from public and private laboratories across Canada. Where feasible, LTC patients were identified by submitting jurisdictions. Data on urinary isolates from identified LTC patients were analysed using the first isolate per patient per species per calendar year. The data were described by distribution of age group, sex, species and antimicrobial susceptibility. Antimicrobials were classified by the World Health Organization's 'Access, Watch and Reserve' (AWaRe) framework and a weighted-incidence syndromic combination antibiogram was constructed. As part of AMRNet program development, in some jurisdictions, only certain specimen types or organisms were submitted. Not all jurisdictions participated every year. Due to privacy precautions, some values rely on estimations. Results: From 2016-2024, AMRNet received data on 216,524 isolates from five provinces (BC, NL, ON, PEI, SK). Most isolates (98%) were from patients aged >=60, with those >=80 years representing 80%; females predominated across all age groups. Urine represented >99% of submitted data. The most common organisms identified from urinary isolates were Escherichia coli (51%), Klebsiella pneumoniae (14%) and Proteus mirabilis (12%). Non susceptibility varied across organisms: E. coli demonstrated higher non-susceptibility to several commonly used agents including fluoroquinolones (44%) and third generation cephalosporins (18%) while K. pneumoniae displayed high non-susceptibility to nitrofurantoin (56%). Among P. mirabilis, 26% were non susceptible to ciprofloxacin. Aminoglycoside and carbapenem resistance were low. When antimicrobials were grouped by WHO AWaRe categories, more than half of E. coli isolates were non-susceptible to at least one Watch antimicrobial. Interpretation: AMRNet lab-based surveillance data can help describe national AMR patterns among LTC residents. Although limitations exist and identifying LTC patients in lab-based datasets can be challenging in some jurisdictions, these data provide a feasible and cost-effective means of tracking national resistance trends among an at-risk population.
ER -