Longitudinal monitoring of sewershed resistomes in socioeconomically diverse urban neighborhoods.

Background: Understanding factors associated with antimicrobial resistance (AMR) distribution across populations is a necessary step in planning mitigation measures. While associations between AMR and socioeconomic-status (SES), including employment and education have been increasingly recognized in low- and middle-income settings, connections are less clear in high-income countries where SES remains an important influence on other health outcomes.

Methods: We explored the relationship between SES and AMR in Calgary, Canada using spatially-resolved wastewater-based surveillance of resistomes detected by metagenomics across eight socio-economically diverse urban neighborhoods.

Cost-Effectiveness of Semaglutide in Patients With Obesity and Cardiovascular Disease.

Background: Randomized clinical trials have shown that semaglutide is associated with a clinically relevant reduction in body weight and a lower risk of adverse cardiovascular events in those who are overweight or obese with a history of cardiovascular disease but no diabetes. The objective of this study was to assess the cost-effectiveness of semaglutide for this indication.

Methods: A decision analytic Markov model was used to compare the lifetime benefits and costs of semaglutide 2.

Rates of post procedural prophylactic antibiotic use following cardiac implantable electronic device insertion and the impact on surgical site infections in Alberta, Canada.

Background: The necessity of post procedural prophylactic antibiotics following clean surgeries is controversial. While most evidence suggests that there is no benefit from these additional antibiotics and guidelines do not support their use, there is a paucity of evidence as to how often they are still being used and their impact on infection outcomes. The current study assessed the use of prophylactic antibiotics following cardiac implantable electronic device (CIED) implantations in the province of Alberta, and their impact on infection and mortality.

Evaluation of In-Hospital and Community-Based Healthcare Utilization and Costs During the Coronavirus 2019 (COVID-19) Pandemic in Alberta, Canada: A Population-Based Descriptive Study.

Background: Assessing the financial burden of COVID-19 is important for planning health services and resource allocation to inform future pandemic response.

Objectives: This study examines the changing dynamics in healthcare utilization patterns and costs from a public healthcare perspective during the COVID-19 pandemic in Alberta, Canada.

Design: Population-based descriptive study.

A quasi-experimental analysis comparing antimicrobial usage on COVID-19 and non-COVID-19 wards.

Objective: To describe antimicrobial usage (AMU) trends before and during the coronavirus disease 2019 (COVID-19) pandemic, between COVID-19 and non-COVID-19 wards, and if there was any association with a COVID-19 order set.

Design: Quasi-experimental retrospective interrupted time series analysis of AMU rates with a contemporaneous comparison of COVID-19 versus non-COVID-19 control wards. Analysis using incidence rate ratios (IRR) was conducted using a Poisson regression generalized linear model.

Evaluating the costs of bloodstream infections: a population-based cohort study in a large metropolitan Canadian region.

Objectives: We evaluated the costs of susceptible and resistant bloodstream infections (BSIs) in adults. Secondary outcomes were the impact of BSI on length of stay (LOS), readmissions and death.

Methods: We examined a population-based retrospective cohort of blood cultures from 2011 to 2018 in Calgary, Canada, linked to microcosting and gross costing data.

Assessing the impact of discontinuation of formulary prior authorization on antibiotic prescribing.

Objective: To compare prescribing patterns of restricted antimicrobials before and after the removal of prior authorization and to develop a prospective audit and feedback program to mitigate the potential inappropriate prescribing of these antimicrobials.

Methods: An interrupted time-series analysis assessing the trends in antibiotic use was conducted between May 2020 and February 2023 in large urban hospitals, where all ASP activities were discontinued in May 2022 and a pilot prospective audit and feedback (PAF) program was initiated in January 2023.

Results: The collective change in restricted antibiotic utilization after the removal of prior authorization was trending towards increased utilization but was not statistically significant.

Microbiology of cardiac implantable electronic device infections in Calgary, Canada.

The microbiology of cardiac implantable electronic device (CIED) infections in Calgary, Alberta was described, identifying 50 infections from 2013 to 2019. The majority were (40.0%).

Machine learning risk estimation and prediction of death in continuing care facilities using administrative data.

In this study, we aimed to identify the factors that were associated with mortality among continuing care residents in Alberta, during the coronavirus disease 2019 (COVID-19) pandemic. We achieved this by leveraging and linking various administrative datasets together. Then, we examined pre-processing methods in terms of prediction performance.

Baseline prevalence of antimicrobial resistance in patients who develop a surgical site infection in hip and knee replacements: A brief report.

Prior to clean surgeries, decolonization with topical antimicrobials may lead to an increase in antimicrobial resistance. To provide a baseline prevalence of resistance to topical antimicrobials, in Alberta, specimens were collected from surgical site infections following hip and knee replacements. Among 81 samples with complex surgical site infections, in 43 specimens Staphylococcus species were isolated.

Healthcare utilization and adverse outcomes stratified by sex, age and long-term care residency using the Alberta COVID-19 Analytics and Research Database (ACARD): a population-based descriptive study.

Background: Understanding the epidemiology of Coronavirus Disease of 2019 (COVID-19) in a local context is valuable for both future pandemic preparedness and potential increases in COVID-19 case volume, particularly due to variant strains.

Methods: Our work allowed us to complete a population-based study on patients who tested positive for COVID-19 in Alberta from March 1, 2020 to December 15, 2021. We completed a multi-centre, retrospective population-based descriptive study using secondary data sources in Alberta, Canada.

Complex cardiac implantable electronic device infections in Alberta, Canada: An epidemiologic cohort study of validated administrative data.

Objective: To establish the epidemiology of cardiac implantable electronic device (CIED) infections in Alberta, Canada, using validated administrative data.

Design: Retrospective, population-based cohort study.

Setting: Alberta Health Services is a province-wide health system that services all of Alberta, Canada.

Economic evaluation in cardiac electrophysiology: Determining the value of emerging technologies.

Cardiac electrophysiology is a constantly evolving speciality that has benefited from technological innovation and refinements over the past several decades. Despite the potential of these technologies to reshape patient care, their upfront costs pose a challenge to health policymakers who are responsible for the assessment of the novel technology in the context of increasingly limited resources. In this context, it is critical for new therapies or technologies to demonstrate that the measured improvement in patients' outcomes for the cost of achieving that improvement is within conventional benchmarks for acceptable health care value.

Impact of Clostridioides difficile length of treatment on rates of recurrence in patients on concurrent antibiotics.

Background: Clostridioides difficile infection (CDI) is principally health care-associated, with a substantial impact on morbidity and mortality. The guidelines recommend CDI therapy for 10 days; however, it is often extended in practice when concurrent antibiotics are used. The impact of the extended duration of therapy remains unclear.

Pilot study evaluating intravenous amoxicillin-clavulanate as an alternative to piperacillin-tazobactam for general surgery patients.

In this point-prevalence survey followed by prospective audit and feedback at 4 tertiary-care hospitals in Calgary, Alberta, Canada, we evaluated whether intravenous amoxicillin-clavulanate may be used as a narrower-spectrum alternative to intravenous piperacillin-tazobactam for patients admitted to general surgery services.

Surveillance for SARS-CoV-2 and its variants in wastewater of tertiary care hospitals correlates with increasing case burden and outbreaks.

Wastewater-based SARS-CoV-2 surveillance enables unbiased and comprehensive monitoring of defined sewersheds. We performed real-time monitoring of hospital wastewater that differentiated Delta and Omicron variants within total SARS-CoV-2-RNA, enabling correlation to COVID-19 cases from three tertiary-care facilities with >2100 inpatient beds in Calgary, Canada. RNA was extracted from hospital wastewater between August/2021 and January/2022, and SARS-CoV-2 quantified using RT-qPCR.

Validating administrative data to identify complex surgical site infections following cardiac implantable electronic device implantation: a comparison of traditional methods and machine learning.

Background: Cardiac implantable electronic device (CIED) surgical site infections (SSIs) have been outpacing the increases in implantation of these devices. While traditional surveillance of these SSIs by infection prevention and control would likely be the most accurate, this is not practical in many centers where resources are constrained. Therefore, we explored the validity of administrative data at identifying these SSIs.

A Time Series Analysis Evaluating Antibiotic Prescription Rates in Long-Term Care during the COVID-19 Pandemic in Alberta and Ontario, Canada.

The COVID-19 pandemic affected access to care, and the associated public health measures influenced the transmission of other infectious diseases. The pandemic has dramatically changed antibiotic prescribing in the community. We aimed to determine the impact of the COVID-19 pandemic and the resulting control measures on oral antibiotic prescribing in long-term care facilities (LTCFs) in Alberta and Ontario, Canada using linked administrative data.

Antimicrobial resistance (AMR) in COVID-19 patients: a systematic review and meta-analysis (November 2019-June 2021).

Background: Pneumonia from SARS-CoV-2 is difficult to distinguish from other viral and bacterial etiologies. Broad-spectrum antimicrobials are frequently prescribed to patients hospitalized with COVID-19 which potentially acts as a catalyst for the development of antimicrobial resistance (AMR).

Objectives: We conducted a systematic review and meta-analysis during the first 18 months of the pandemic to quantify the prevalence and types of resistant co-infecting organisms in patients with COVID-19 and explore differences across hospital and geographic settings.

Knowledge Gaps in the Understanding of Antimicrobial Resistance in Canada.

Current limitations in the understanding and control of antimicrobial resistance (AMR) in Canada are described through a comprehensive review focusing on: (1) treatment optimization; (2) surveillance of antimicrobial use and AMR; and (3) prevention of transmission of AMR. Without addressing gaps in identified areas, sustained progress in AMR mitigation is unlikely. Expert opinions and perspectives contributed to prioritizing identified gaps.

Mathematical model of the cost-effectiveness of the BioFire FilmArray Blood Culture Identification (BCID) Panel molecular rapid diagnostic test compared with conventional methods for identification of Escherichia coli bloodstream infections.

Background: Gram-negative pathogens, such as Escherichia coli, are common causes of bloodstream infections (BSIs) and increasingly demonstrate antimicrobial resistance. Molecular rapid diagnostic tests (mRDTs) offer faster pathogen identification and susceptibility results, but higher costs compared with conventional methods. We determined the cost-effectiveness of the BioFire FilmArray Blood Culture Identification (BCID) Panel, as a type of mRDT, compared with conventional methods in the identification of E.

Economic burden of surgical management of surgical site infections following hip and knee replacements in Calgary, Alberta, Canada.

Objective: To evaluate the cost of 1-stage and 2-stage revisions, debridement, antibiotic and implant retention (DAIR) and DAIR with liner exchange for complex surgical site infections (SSIs) following hip and knee replacements.

Design: Retrospective population-based economic analysis of patients undergoing intervention for SSIs between April 1, 2012 and March 31, 2019.

Setting: The study was conducted in the Calgary zone of Alberta Health Services (AHS) in Canada.