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dc.contributor.advisor McEwen, Scott A Otto, Simon James Garfield 2011-04-20 2011-04-29T13:49:15Z 2011-04-29T13:49:15Z 2011-04-29
dc.description.abstract Saskatchewan is the only province in Canada to have routinely tested the antimicrobial susceptibility of all provincially reported human cases of campylobacteriosis. From 1999 to 2006, 1378 human Campylobacter species infections were tested for susceptibility at the Saskatchewan Disease Control Laboratory using the Canadian Integrated Program for Antimicrobial Resistance Surveillance panel and minimum inhibitory concentration (MIC) breakpoints. Of these, 1200 were C. jejuni, 129 were C. coli, with the remaining made up of C. lari, C. laridis, C. upsaliensis and undifferentiated Campylobacter species. Campylobacter coli had significantly higher prevalences of ciprofloxacin resistance (CIPr), erythromycin resistance (ERYr), combined CIPr-ERYr resistance and multidrug resistance (to three or greater drug classes) than C. jejuni. Logistic regression models indicated that CIPr in C. jejuni decreased from 1999 to 2004 and subsequently increased in 2005 and 2006. The risk of CIPr was significantly increased in the winter months (January to March) compared to other seasons. A comparison of logistic regression and Cox proportional hazard survival models found that the latter were better able to detect significant temporal trends in CIPr and tetracycline resistance by directly modeling MICs, but that these trends were more difficult to interpret. Scan statistics detected significant spatial clusters of CIPr C. jejuni infections in urban centers (Saskatoon and Regina) and temporal clusters in the winter months; the space-time permutation model did not detect any space-time clusters. Bernoulli scan tests were computationally the fastest for cluster detection, compared to ordinal MIC and multinomial antibiogram models. eBURST analysis of antibiogram patterns showed a marked distinction between case and non-case isolates from the scan statistic clusters. Multilevel logistic regression models detected significant individual and regional contextual risk factors for infection with CIPr C. jejuni. Patients infected in the winter, that were between the ages of 40-45 years of age, that lived in urban regions and that lived in regions of moderately high poultry density had higher risks of a resistant infection. These results advance the epidemiologic knowledge of CIPr C. jejuni in Saskatchewan and provide novel analytical methods for antimicrobial resistance surveillance data in Canada. en_US
dc.description.sponsorship Saskatchewan Disease Control Laboratory (Saskatchewan Ministry of Health); Laboratory for Foodborne Zoonoses (Public Health Agency of Canada); Centre for Foodborne, Environmental and Zoonotic Infectious Diseases (Public Health Agency of Canada); Ontario Veterinary College Blake Graham Fellowship en_US
dc.language.iso en en_US
dc.subject Campylobacter en_US
dc.subject Campylobacter jejuni en_US
dc.subject Saskatchewan en_US
dc.subject human en_US
dc.subject epidemiology en_US
dc.subject antimicrobial en_US
dc.subject antibiotic en_US
dc.subject minimum inhibitory concentration en_US
dc.subject logistic regression en_US
dc.subject survival anlysis en_US
dc.subject Cox proportional hazard model en_US
dc.subject analytical models en_US
dc.subject scan statistics en_US
dc.subject eBURST en_US
dc.subject risk factor en_US
dc.subject prevalence en_US
dc.subject AMR en_US
dc.subject MIC en_US
dc.subject spatial cluster en_US
dc.subject temporal cluster en_US
dc.subject space-time cluster en_US
dc.subject Bernoulli en_US
dc.subject ordinal en_US
dc.subject multinomial en_US
dc.subject space-time permutation en_US
dc.subject multilevel model en_US
dc.subject antimicrobial resistance en_US
dc.subject antibiotic resistance en_US
dc.subject ciprofloxacin en_US
dc.subject erythromycin en_US
dc.subject fluoroquinolone en_US
dc.subject macrolide en_US
dc.subject tetracycline en_US
dc.type Thesis en_US Veterinary Science en_US Doctor of Philosophy en_US Population Medicine en_US

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