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Links between quantitative antibiotic use and the emergence of bacterial resistance are well documented. This study presents benchmark antimicrobial use (AMU) rates for inpatient adult populations in acute-care hospitals across Canada.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>In this retrospective surveillance study, acute-care adult hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) submitted annual AMU data on all systemic antimicrobials from 2009 to 2016. Information specific to intensive care units (ICUs) and non-ICU wards were available for 2014\u20132016. Data were analyzed using defined daily doses (DDD) per 1000 patient days (DDD\/1000pd).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Between 2009 and 2016, 16\u201318 CNISP adult hospitals participated each year and provided their AMU data (22 hospitals participated in \u22651\u2009year of surveillance; 11 in all years). From 2009 to 2016, there was a significant reduction in use (12%) (from 654 to 573 DDD\/1000pd, <jats:italic>p<\/jats:italic>\u2009=\u20090.03). Fluoroquinolones accounted for the majority of this decrease (47% reduction in combined oral and intravenous use, from 129 to 68 DDD\/1000pd, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.002). The top five antimicrobials used in 2016 were cefazolin (78 DDD\/1000pd), piperacillin-tazobactam (53 DDD\/1000pd), ceftriaxone (49 DDD\/1000pd), vancomycin (combined oral and intravenous use was 44 DDD\/1000pd; 7% of vancomycin use was oral), and ciprofloxacin (combined oral and intravenous use: 42 DDD\/1000pd). Among the top 10 antimicrobials used in 2016, ciprofloxacin and metronidazole use decreased significantly between 2009 and 2016 by 46% (<jats:italic>p\u2009=<\/jats:italic>\u00a00.002) and 26% (<jats:italic>p<\/jats:italic>\u2009=\u20090.002) respectively. Ceftriaxone (85% increase, <jats:italic>p<\/jats:italic>\u2009=\u20090.0008) and oral amoxicillin-clavulanate (140% increase, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) use increased significantly but contributed only a small component (8.6 and 5.0%, respectively) of overall use.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study represents the largest collection of dispensed antimicrobial use data among inpatients in Canada to date. Between 2009 and 2016, there was a significant 12% decrease in AMU, driven primarily by a 47% decrease in fluoroquinolone use. Modest absolute increases in parenteral ceftriaxone and oral amoxicillin-clavulanate use were noted but contributed a small amount of total AMU. Ongoing national surveillance is crucial for establishing benchmarks and antimicrobial stewardship guidelines.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13756-020-0684-2","type":"journal-article","created":{"date-parts":[[2020,2,13]],"date-time":"2020-02-13T14:02:47Z","timestamp":1581602567000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016"],"prefix":"10.1186","volume":"9","author":[{"name":"the Canadian Nosocomial Infection Surveillance Program","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wallis","family":"Rudnick","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Science","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J. 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Accessed 5 Mar 2019."}],"container-title":["Antimicrobial Resistance &amp; Infection Control"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13756-020-0684-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13756-020-0684-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13756-020-0684-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T00:40:23Z","timestamp":1613090423000},"score":1,"resource":{"primary":{"URL":"https:\/\/aricjournal.biomedcentral.com\/articles\/10.1186\/s13756-020-0684-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,13]]},"references-count":36,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["684"],"URL":"https:\/\/doi.org\/10.1186\/s13756-020-0684-2","relation":{},"ISSN":["2047-2994"],"issn-type":[{"value":"2047-2994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,13]]},"assertion":[{"value":"25 October 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 January 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 February 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Surveillance of AMU at participating hospitals is considered to be quality improvement and within the mandate of hospital infection prevention and control programs and does not constitute human research. As surveillance did not involve any alteration in patient care and there were no patient identifiers or patient-level data collected, institutional research board approval was not routinely solicited. All data were aggregated with the lowest level of aggregation being at the hospital ward. All data submitted to PHAC were kept strictly confidential.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"32"}}