Increasing rates of ESBL-producing <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> in Canadian Hospitals: 17 years of the CANWARD study, 2007–23
Bibliographic record
Abstract
OBJECTIVES: ESBL-producing Escherichia coli and Klebsiella pneumoniae are major causes of infections, including urinary tract, abdominal, nosocomial pneumonia, diabetic foot and bloodstream infections. This study examines trends in their prevalence, genotypes and antibiotic susceptibility and identifies at-risk populations. METHODS: Between 2007 and 2023, bacterial isolates were collected from sentinel laboratories (CANWARD study). Identification, antimicrobial susceptibility testing and WGS were performed. Trends in incidence, resistance patterns, beta-lactamase genotypes and demographic associations were analysed using multifactorial regression and trend analysis. RESULTS: Among 11 931 E. coli and 3973 K. pneumoniae isolates, 8.4% and 5.6%, respectively, were ESBL-producers, with prevalence increasing from 2007-08 to 2021-23 (E. coli: 3.6% to 11.8%; K. pneumoniae: 2.2% to 8.0%; P < 0.001). Susceptibility among ESBL E. coli declined for amoxicillin-clavulanate (78.7% to 28.6%) but increased for gentamicin (43.5% to 70.3%) (P < 0.001). MDR among ESBL-positive E. coli declined (82.4% to 63.4%; P < 0.001) but remained stable among ESBL-positive K. pneumoniae. ESBL E. coli was associated with inpatients, respiratory specimens and males, while K. pneumoniae was linked to inpatient status and regional variations. Genotypic analysis showed increasing blaCTX-M-15 in K. pneumoniae and blaCTX-M-27 in E. coli. blaOXA-1 and blaTEM-1 were associated with MDR and first-generation β-lactam/β-lactamase inhibitor resistance. CONCLUSION: ESBL E. coli and K. pneumoniae have increased in prevalence, with evolving resistance patterns. While MDR in E. coli has declined, resistance to key antimicrobials, including sulphonamides, fluoroquinolones and first-generation β-lactam/β-lactamase inhibitors remains high. Resistance rates varied significantly by region of Canada and by inpatient status, sex and specimen type.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".