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Objectives: The antimicrobial susceptibility of Neisseria gonorrhoeae isolates from Saskatchewan was determined retrospectively (2003-15) to ascertain temporal trends to both current and older antimicrobials used for treatment.Method: The agar dilution method was used to test the antimicrobial susceptibilities of 685 isolates to seven antibiotics.Results: Over the period, only three (0.4%) gonococcal isolates had reduced susceptibility to cefixime and/or ceftriaxone. All isolates were susceptible to spectinomycin. Over 95% of the isolates tested were susceptible to azithromycin except in 2010 and 2013 (27.6% and 7.2% resistant, respectively). One isolate was resistant to both azithromycin and cefixime. Ciprofloxacin resistance was seen in < 5% of isolates prior to 2010, but in > 5% thereafter. From 2006 to 2012, and in 2015, penicillin resistance was detected in < 5% (0%-4.0%) of isolates, but in > 5% for the rest of the study period. Tetracycline resistance remained >5% (11.8%-89.1%) throughout the study. Plasmid-mediated resistance to tetracycline fluctuated between 0% and 17.5% of isolates tested. Four isolates were MDR and two isolates were XDR.Conclusions: N. gonorrhoeae isolates were largely susceptible (∼85%) to antibiotics no longer recommended for treatment, such as penicillin and ciprofloxacin. Gonorrhoea in Saskatchewan is primarily (>95%) diagnosed by nucleic acid amplification testing, which does not permit antimicrobial susceptibility testing. The development of molecular testing, or point-of-care tests, to evaluate antimicrobial susceptibility, would enhance knowledge of true levels of resistance and allow discretion as to whether older but still effective antibiotics could be used in individual patient care. [ABSTRACT FROM AUTHOR]

Surveillance of Staphylococcus aureus infections in 3 northern remote communities of Saskatchewan was undertaken. Rates of methicillin-resistant infections were extremely high (146-482/10,000 population), and most (98.2%) were caused by USA400 strains. Although USA400 prevalence has diminished in the United States, this strain is continuing to predominate throughout many northern communities in Canada. [ABSTRACT FROM AUTHOR]

A reassortant influenza A(H1N1) virus of swine origin distinct from the pandemic H1N1 2009 strain was isolated from 3 patients, all of whom worked at the same large hog operation in Saskatchewan, Canada. The genomic composition of the isolates has not been previously reported, to our knowledge, and was the product of a genetic reassortment between seasonal H1N1 and triple-reassortant influenza virus that emerged in North American swine during the late 1990s. The neuraminidase and hemagglutinin genes of A/ Saskatchewan/5350/2009, A/Saskatchewan/5351/2009, and A/ Saskatchewan/5131/2009 were derived from human H1N1 virus and were closely related to those of A/Brisbane/59/2007. [ABSTRACT FROM AUTHOR]

Abstract: Antimicrobial resistance is a growing concern especially in many remote northern communities of Canada where antimicrobials are liberally used. In this study, 1418 Escherichia coli urinary tract infection (UTI) isolates, obtained over a 2.5-year period (October 2005–March 2008), from 3 remote northern sites in Saskatchewan, Canada, were identified. Antimicrobial susceptibility testing of the first 544 clinically significant isolates revealed high prevalence of resistance to trimethoprim–sulfamethoxazole (TMP-SXT) (30.7%). Pulsed-field gel electrophoresis (PFGE) of 165 TMP-SXT–resistant isolates revealed a heterogeneous population. Multilocus sequence typing identified 7 STs from 9 identified PFGE clusters, which included separate PFGE clusters of fluoroquinolone-resistant and -susceptible ST131 isolates. The majority of TMP-SXT–resistant isolates (85.5%) were found to carry class 1 integrons, and plasmids from 62 (81%) of 77 representative isolates were successfully transformed into E. coli DH10B. Overall, ampicillin was the most common plasmid-encoded resistance phenotype transferred with TMP-SXT at 60% (37/62). Further characterization of 52 plasmids by restriction fragment length polymorphism and replicon typing revealed the presence of many plasmid lineages, suggesting that the elevated rates of TMP-SXT resistance in these communities are most likely attributed to the horizontal transfer of class 1 integrons. Results from this study emphasize the importance of continued surveillance of remote northern communities in order to optimize the efficacy of empiric UTI treatment. [Copyright &y& Elsevier]

Methicillin-resistant Staphylococcus aureus (MRSA) is a public health threat within the general community, thereby warranting identification of MRSA reservoirs within the community. Computer terminals in schools were sampled for S. aureus and methicillin-resistant staphylococci. The overall prevalence of MRSA on computer keyboards was low: 0.68% for a postsecondary institution and 2% and 0% for two secondary institutes. The MRSA isolate from the postsecondary institution did not correspond to the Canadian epidemic clusters, but is related to the USA 700 cluster, which contains strains implicated in outbreaks within the U.S. The isolate from the secondary institute's keyboard was typed as CMRSA7 (USA 400), a strain that has been implicated in both Canadian and U.S. epidemics. Methicillin-resistant S. haemolyticus and S. epidermidis were also isolated from keyboards, indicating that a mixed community of methicillinresistant staphylococci can be present on keyboards. Although the prevalence was low, the presence of MRSA combined with the high volume of traffic on these student computer terminals demonstrates the potential for publicaccess computer terminals and computer rooms at educational institutes to act as reservoirs. [ABSTRACT FROM AUTHOR]

To describe a historical baseline of antimicrobial resistance (AMR) profiles for human clinical Campylobacter species isolates obtained by laboratory surveillance in the province of Saskatchewan from 1999 to 2006; to determine if there were differences in resistance between Campylobacter jejuni and Campylobacter coli ; and to determine if there were changes in the annual resistance levels in the two species. One thousand three hundred seventy-eight Campylobacter isolates were subjected to antimicrobial susceptibility testing using the E-test method. Annual resistance levels in C. jejuni and C. coli were compared using logistic regression models. One thousand two hundred (87.1%) isolates were C. jejuni and 129 (9.4%) were C. coli . Resistance in C. jejuni isolates included ciprofloxacin (CIP: 9.4%), erythromycin (ERY: 0.5%), and tetracycline (33.3%). CIP resistance in C. jejuni was higher in 1999 (15.5%, odds ratio [OR] = 3.96, p  = 0.01), 2000 (12.7%, OR = 3.10, p  = 0.01), 2005 (10.2%, OR = 2.47, p  = 0.05), and 2006 (13.0%, OR = 3.22, p  = 0.01) compared with 2004 (4.4%). C. coli had significantly higher CIP resistance (15.5%, OR = 1.78, p  = 0.03), ERY resistance (13.2%, OR = 60.12, p  < 0.01), multidrug resistance (2.3%, OR = 36.29, p  < 0.01), and CIP-ERY resistance (3.1%, OR = 50.23, p  < 0.01) compared with C. jejuni . This represents the first and most current report of AMR of the collective human Campylobacter isolates from a province in Canada and provides a baseline against which current and future resistance patterns can be compared. Fluoroquinolone resistance in C. jejuni isolates fluctuated from 1999 to 2006, including an increased prevalence in 2005-2006, while macrolide/lincosamide resistance remained very low. Human clinical C. jejuni isolates from Saskatchewan demonstrated resistance to multiple antimicrobials but had significantly less fluoroquinolone and macrolide resistance than C. coli isolates.

Objective: HIV incidence in the Canadian province of Saskatchewan, where Indigenous persons make up 80% of those infected, are among the highest on the continent. Reports of accelerated HIV progression, associated with carriage of certain human leukocyte antigen (HLA) alleles (including the typically protective HLA-B*51) have also emerged from the region. Given that acquisition of HIV preadapted to host HLA negatively impacts clinical outcome, we hypothesized that HIV-host adaptation may be elevated in Saskatchewan., Design: Comparative analysis of population-level HIV sequence datasets from Saskatchewan and elsewhere in Canada/USA., Methods: We analyzed 1144 HIV subtype B Pol sequences collected in Saskatchewan between 2000 and 2016, comprising ∼65% of cumulative provincial HIV cases, for the presence of 70 HLA-associated Pol mutations. Sequences from British Columbia (N = 6525) and elsewhere in Canada/USA (N = 6517) were used for comparison. HIV adaptation levels to 34 HLA alleles were also computed. Putative HIV transmission clusters were identified, and the prevalence of HLA-associated adaptations within and outside these clusters was investigated., Results: Analyses confirmed significantly elevated and temporally increasing levels of HIV adaptation to commonly expressed HLA alleles, in particular B*51. Notably, HLA-adapted HIV strains were significantly enriched among phylogenetic clusters in Saskatchewan., Conclusion: Extensive circulating HIV adaptation to HLA in Saskatchewan provides a plausible explanation for accelerated progression, while enrichment of adapted variants in phylogenetic clusters suggests they are being widely transmitted. Results highlight the utility of Pol sequences, routinely collected for drug resistance monitoring, for surveillance of HIV-host adaptation, and underscore the urgent need to expand HIV prevention and treatment programmes in Saskatchewan.

Objectives: To investigate the molecular epidemiology of isolates of Neisseria gonorrhoeae from Saskatchewan, Canada, using Neisseria gonorrhoeae multi antigen sequence typing (NG-MAST), and to assess associations between antimicrobial susceptibility (AMS) and specific strain types (STs)., Methods: 320 consecutive gonococcal isolates, collected between 2003 and 2008, were typed by NG-MAST. STs were grouped if one of their alleles was common and the other differed by ≤1% in DNA sequence. AMS was determined by agar dilution (CLSI) to seven antibiotics., Results: N gonorrhoeae isolates were resolved into 82 individual NG-MAST STs and 18 NG-MAST ST groups with groups 25, 3655, 921, 3654, 3657 and 3656 comprising 53.4% (171/320) of the isolates. N gonorrhoeae isolates susceptible to all the tested antimicrobials were significantly (p<0.05) associated with ST 25 (87%). Other significant associations between ST and AMS included: ST 3654 and isolates with minimum inhibitory concentrations of ≥0.03 mg/L to third generation cephalosporins; ST 3711 (100%) and TRNG; and ST/group 3654 (43%) and chromosomal resistance to penicillin and tetracycline. Several NG-MAST STs/groups were significantly associated with isolates with chromosomal resistance to tetracycline. Isolates resistant to ciprofloxacin (n=5) and azithromycin (n=2) appeared as individual STs. Significant associations were observed among individual STs, sex and age of the patient, and regional and temporal distributions., Conclusions: Associations between N gonorrhoeae AMS and NG-MAST STs were identified and may be useful in predicting AMS regionally. Because STs in different countries vary considerably, the use of NG-MAST for the prediction of AMS globally requires further study., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

A population-based study combining (i) antimicrobial, (ii) genetic, and (iii) virulence analyses with molecular evolutionary analyses revealed segregative characteristics distinguishing human clinical and bovine Escherichia coli O157 strains from western Canada. Human (n = 50) and bovine (n = 50) strains of E. coli O157 were collected from Saskatchewan and Manitoba in 2006 and were analyzed by using the six-marker lineage-specific polymorphism assay (LSPA6), antimicrobial susceptibility analysis, the colicin assay, plasmid and virulence profiling including the eae, ehxA, espA, iha, stx1, stx2, stx2c, stx2d, stx2d-activatable, stx2e, and stx2f virulence-associated genes, and structure analyses. Multivariate logistic regression and Fisher's exact test strongly suggested that antimicrobial susceptibility was the most distinctive characteristic (P = 0.00487) associated with human strains. Among all genetic, virulence, and antimicrobial determinants, resistance to tetracycline (P < 0.000) and to sulfisoxazole (P < 0.009) were the most strongly associated segregative characteristics of bovine E. coli O157 strains. Among 11 virulence-associated genes, stx2c showed the strongest association with E. coli O157 strains of bovine origin. LSPA6 genotyping showed the dominance of the lineage I genotype among clinical (90%) and bovine (70%) strains, indicating the importance of lineage I in O157 epidemiology and ecology. Population structure analysis revealed that the more-diverse bovine strains came from a unique group of strains characterized by a high degree of antimicrobial resistance and high frequencies of lineage II genotypes and stx2c variants. These findings imply that antimicrobial resistance generated among bovine strains of E. coli O157 has a large impact on the population of this human pathogen.

A longitudinal study combining multilocus sequence typing with molecular evolutionary analysis determined the distribution, population structure, and evolution of antibiotic resistance in Neisseria gonorrhoeae isolates in Saskatchewan that were collected between 2005 and 2008. Of 195 gonococcal isolates examined, 29 sequence types (STs) were identified with 3 major circulating strains (ST-1 through ST-3) comprising 52% of all gonococcal isolates studied. The prevalences, persistence, distribution patterns, and clonalities of these isolates strongly suggest that gonorrhea endemicity within this broad geographic region was driven by these 3 circulating strains. ST-1 exhibited a significantly (P = 0.001) higher prevalence throughout the study than did the others, accounting for ∼25% of the tested isolates each year. The spatial distributions of the gonococcal strains indicated that ST-1 in 2007 entered a linear component of the sexual network, reaching the remote north and resulting in the further spread and maintenance of infection. Ciprofloxacin and azithromycin resistances were observed in distantly related gonococcal lineages, clearly indicating the convergent acquisition of these antibiotic-resistant phenotypes. In addition, all ciprofloxacin- and azithromycin-resistant lineages were found at the edges of the minimum spanning tree, far from the major lineages, suggesting that these antibiotic phenotypes were most likely introduced into the province. In contrast, resistance to penicillin was found mostly in the endemic gonococcal lineages, suggesting that penicillin resistance was probably acquired in Saskatchewan as a result of spontaneous mutations in already-established lineages. Tetracycline resistance was present in all STs except one, indicating its ubiquitous nature in the gonococcal population studied.

Background: Performances of the BD ProbeTec Chlamydia trachomatis (CT)/Neisseria Gonorrhoeae (GC) Q(x) Amplified DNA Assay reagents on a BD Viper System with XTR Technology and APTIMA COMBO 2 Assay reagents on a TIGRIS DTS platform, for detection of both CT and GC were compared., Methods: A total of 1018 first-void urine specimens were tested for the presence of CT and GC DNA using the 2 assays., Results: CT was detected in 143 specimens (14%). Eight specimens exhibited discordant results, and they were divided equally between the 2 assays. Based on the original results, the overall agreement for CT was 99.2%, with 97.1% and 99.5% in agreement with positive and negative specimens, respectively. Cohen's Kappa was 0.967. GC was detected in 27 specimens (2.6%). Two specimens exhibited discordant results, and they were divided equally between the 2 assays. Based on the original results, the overall agreement was 99.8%, with 96.2% and 99.9% in agreement for positive and negative specimens, respectively. Cohen's Kappa was 0.961., Conclusions: There was a high level of agreement between the systems for both CT and GC detection.

Background: Surveillance examining the incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was conducted over 8 years beginning in 2001 in three health regions covering the northern half of Saskatchewan. The annual rate of individuals reported with CA-MRSA infection in these regions dramatically increased from 8.2 per 10,000 population in 2001 (range to 4.4-10.1 per 10,000) to 168.1 per 10,000 in 2006 (range 43.4-230.9 per 10,000). To address this issue, a team of community members, healthcare professionals, educators and research scientists formed a team called "the Northern Antibiotic Resistance Partnership" (NARP) to develop physician, patient, community, and school based educational materials in an attempt to limit the spread of CA-MRSA., Methods: Posters, radio broadcasts, community slide presentations, physician treatment algorithms, patient pamphlets, and school educational programs Do Bugs Need Drugs http://www.dobugsneeddrugs.org and Germs Away http://www.germsaway.ca were provided to targeted northern communities experiencing high rates of infections., Results: Following implementation of this program, the rates of MRSA infections in the targeted communities have decreased nearly two-fold (242.8 to 129.3 infections/10,000 population) from 2006 to 2008. Through pre-and post-educational intervention surveys, this decrease in MRSA infections coincided with an increase in knowledge related to appropriate antimicrobial usage and hand washing in these communities., Conclusion: These educational materials are all freely available http://www.narp.ca and will hopefully aid in increasing awareness of the importance of proper antimicrobial usage and hygiene in diminishing the spread of S. aureus and other infectious diseases in other communities.

Rates of colonization with livestock-associated methicillin-resistant Staphylococcus aureus (MRSA) sequence type 398 have been high for pigs and pig farmers in Canada, but prevalence rates for the general human population are unknown. In this study, 5 LA-MRSA isolates, 4 of which were obtained from skin and soft tissue infections, were identified from 3,687 tested MRSA isolates from persons in Manitoba and Saskatchewan, Canada. Further molecular characterization determined that these isolates all contained staphylococcal cassette chromosome (SCC) mecV, were negative for Panton-Valentine leukocidin, and were closely related by macrorestriction analysis with the restriction enzyme Cfr91. The complete DNA sequence of the SCCmec region from the isolate showed a novel subtype of SCCmecV harboring clustered regularly interspaced short palindromic repeats and associated genes. Although prevalence of livestock-associated MRSA seems to be low for the general population in Canada, recent emergence of infections resulting from this strain is of public health concern.